ROUTINE OR SELECTIVE INTRAOPERATIVE CHOLANGIOGRAPHY? A COMPARATIVE STUDY OF 1500 LAPAROSCOPIC CHOLECYSTECTOMIES sbertona@hospitalaleman.com

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ROUTINE OR SELECTIVE INTRAOPERATIVE CHOLANGIOGRAPHY? A COMPARATIVE STUDY OF 1500 LAPAROSCOPIC CHOLECYSTECTOMIES

7

Argentina

Oral only

Intraoperative cholangiography (IOC) is useful for detecting common bile duct stones (CBDS), defining biliary anatomy, and identifying surgical bile duct injuries (BDI). However, its systematic versus selective use remains controversial. The aim of this study is to evaluate IOC success rate.

A retrospective comparative study was conducted using a prospectively maintained database. We analyzed two consecutive series of patients who underwent laparoscopic cholecystectomy (LC) with either routine IOC (group G1) or selective IOC (group G2). Selective IOC was performed in patients with CBDS risk factors (elevated bilirubin, hyperamylasemia, biliary dilation on ultrasound) and/or urgent surgery. Preoperative, intraoperative, and postoperative variables were analyzed. A positive IOC was defined by detection of CBDS, BDI, or biliary variants.

A total of 1506 patients were included (G1: 1003; G2: 503). G2 had more urgent procedures (36.2% vs 29.7%, p=0.01) and longer operative time (72.2 vs 68.6 min, p=0.01). IOC success was higher in G1 (91.5% vs 82.6%, p<0.001), but positive IOC findings were more frequent in G2 (11.4% vs 6.7%, p=0.04). Residual CBDS, BDI, and biliary variants were comparable between groups. Five BDIs occurred in G1; four undetected by IOC. Major morbidity, reoperation, and readmission rates were similar.

Selective IOC appears safe and effective, with comparable BDI and residual CBDS rates. Its higher diagnostic yield supports its use in selected patients. However, lower IOC success rates highlight the need for continuous training.