Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones; The Lancet, Vol. 351, January 17, 1998, Pgs. 159-161, M. Rhodes; L. Sussman; L. Cohen; M.P. Lewis

• "Routine preoperative cholangiography, in contrast to preoperative ERCP, is quick and simple, and has not been reported to cause morbidity; it may even reduce morbidity during laparoscopic cholecystectomy." Page 159
• "In 80 (17%) of these cases there were stones in the common bile duct. 40 patients were randomized to LECBD and 40 to postoperative ERCP." Page 159
• "By the end of treatment, duct clearance was 100% in the laparoscopic group compared with 93% in the ERCP group." Page 159
• "Hospital stay was a median of 1 day (range 1-26) in the laparoscopic group compared with 3-5 days (range 1-11) in the ERCP group (p=0.0001, 95% C1 1-2)." Page 159
• "LECBD is as effective as ERCP in clearing the common bile duct of stones. There is a non-significant trend to shorter time in the operating theatre and a significantly shorter hospital stay in patients treated by LECBD." Page 159

One hundred laparoscopic choledochotomies with primary closure of the common bile duct, Surgical Endoscopy (2003) 17: 12-18; G. Decker; F. Borie; B. Millat; J.C. Berthou; A. Deleuze; F. Drouard; F. Guillon; J.G. Rodier; A. Fingerhut

• "Choledocholithiasis had been demonstrated preoperatively in 35 patients (35%), suspected in 52 and was incidentally found during routine intraoperative cholangiography in 13 patients." Page 12
• "LCBDE was attempted irrespective of age, ASA score, or the circumstances leading to the preoperative diagnosis or suspicion of CBD stones." Page 12
• "Vacuity of the CBD was achieved in all patients without mortality." Page 12
• "In case of LCBDE, choledochotomy with primary closure without external drainage of the CBD is a safe and efficient alternative, even in patients with acute cholecystitis, cholangitis, or pancreatitis, provided that choledochoscopy visualizes a patent CBD. This technique is applicable in all types of medical institutions if required laparoscopic skills and equipment are available." Page 12
• "All IOC were performed using real-time fluoroscopy and following a technique previously described." Page 13
• "Six patients were referred for surgical treatment after failure of previous endoscopic treatment." Page 14
• "LCBDE was performed by straight choledochotomy in 85% of all patients, whereas it was preceded by unsuccessful transcystic attempts in the remaining 15 patients." Page 14
• "No patient had a false positive cholangiogram leading to a negative LCBDE through choledochotomy. Median duration of all procedures was 120 min." Page 14
• "These advantages should encourage a wider use of this fully integrated, single-stage laparoscopic treatment of CBD stones in patients fit for surgery." Page 17

Intraoperative Cholangiography and Risk of Common Bile Duct Injury During Cholecystectomy; JAMA, April 2, 2003-Vol 289, No. 13, Pgs. 1639-1644, David R. Flum, MD, MPH; E. Patchen Dellinger, MD; Allen Cheadle, PhD; Leighton Chan, MD, MPH; Thomas Koepsell, MD MPH

• "CBD injury is the leading cause of medical malpractice claims against general surgeons." Page 1639
• "The results of our study indicated that not using an IOC during cholecystectomy was associated with a 50% to 70% increase in the risk of CBD injury." Page 1642
• "Cost analyses suggest significant gross savings, and in a modeled analysis, IOC routine performed was associated with a cost/life-year saved of approximately $13,000." Page 1643
• "When considering CBD injury from a public health perspective, the experience of the community at large is more important than the experience of individual surgeons." Page 1643
• "Intraoperative cholangiography can provide information about the presence of CBD stones and show a surgical road map of the CBD." Page 1639

Value of routine intraoperative cholangiography in detecting aberrant bile ducts and bile duct injuries during laparoscopic cholecystectomy; British Journal of Surgery 1996, 83, Pgs. 171-175, E. Kullman; K. Borch; E. Lindstrom; J. Svanvik; B. Anderberg

• "In this study there were no complications caused by the cholangiographic procedure, and the authors consider it to be an essential component of laparoscopic cholecystectomy." Page 174
• "These results show that routine intraoperative cholangiography is feasible and provides valuable information about the anatomy of the biliary tract, thereby improving the safety of laparoscopic cholecystectomy." Page 171
• "Routine use of intraoperative cholangiography is strongly recommended." Page 171
• "The incidence of aberrant bile ducts is between 14 and 28 per cent in autopsy series. Moossa et al emphasized that the presence of a bile duct aberration does not excuse bile duct injury, and that intraoperative diagnosis of anatomical variations of the biliary tract contributes greatly to the safety of laparoscopic cholecystectomy." Page 173