Publication: Laparoscopic cholecystectomy; intraoperative cholangiography versus no intraoperative cholangiography. a multi center randomized control trial
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Date
2019
Authors
Zainudin, Nur Zawani
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Abstract
Introduction: Intraoperative cholangiography (IOC) is not something new in the world of
laparoscopic cholecystectomy (LC). However it is still not a favorite method to be applied
as a routine procedure in LC.
Objectives: To determine the feasibility and safety of performing IOC during LC, to detect
the incidence of undiagnosed pre-operative bile duct stone and to identify whether IOC can
prevent bile duct injury.
Method: Multi-center, double blinded randomize controlled trial done from 2016-2018.
Total of 308 patients recruited and divided into 2 arms; with IOC and without IOC.
Exclusion criteria includes in situ biliary stent placement, history of multiple laparotomies,
performed. Out of 308 patients, 154 patients were assigned to IOC group and 154 patients
were assigned to no IOC group.
Results: There was a statistically significant difference of mean operation time between
the group with IOC and no IOC (mean operation time for IOC group was 66.0 minutes (SD
±28.20) compared to no IOC group 55.6 minutes (SD±23.15), t statistics (df) = 306 (6.78),
p-value <0.001). The successful rates for IOC was 98.1%. From 12 cases with presence of
filling defects detected during IOC, 4 cases were confirmed CBD stones. Two were
confirmed after conversion to CBDE and the other 2 cases were confirmed during ERCP
performed. There was only 1 case of bile duct injury noted during IOC. No patients
developed allergic reaction to contrast media and the post-operative complications were
similar in both groups.
Conclusion: IOC is a useful tool to delineate anatomy of bile duct during surgery. It also
can easily been done by any surgeon with lots of practices and a proper guidance. Its use
may be beneficial in selected cases.
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Keywords
intraoperative cholangiography , laparoscopic cholecystectomy