Donald E. Wenner, MD, FACS
General Surgery
Paul Whitwam, MD
General Surgery
David Turner, MD, FACS
General Surgery
Kathy Kennedy, R.T.
Radiology Practitioner Assistant
Student, Weber State University
Abstract
This study was undertaken in order to determine the actual amount of time that a dynamic fluoroscopic intraoperative cholangiogram adds to a laparoscopic cholecystectomy. A secondary objective was to define the information gained from this procedure.
A consecutive case study of 52 patients undergoing laparoscopic cholecystectomy was used. Time was recorded from placement of a laparoscopic hemoclip across the cystic duct at its junction with the gallbladder until successful completion of the intraoperative cholangiogram by adequate imaging of the entire biliary system. Statistical methods were used to determine the mean, median, and range of times for these cases as well as the results and false negative rates associated with dynamic fluoroscopic intraoperative cholangiography.
Cholangiography was successfully completed in 96 percent of patients in this study. The mean time added to laparoscopic cholecystectomy by the addition of dynamic fluoroscopic intraoperative cholangiography was 4.3 minutes. The median time was found to be 3.0 minutes. The times ranged from 2.0 to 16.0 minutes. 15.4 percent of these patients were found to harbor stones within the common bile duct. The false positive rate for dynamic intraoperative fluoroscopic cholangiography was zero in this study.
Dynamic fluoroscopic intraoperative cholangiogram using our technique was found to be fast and efficient. The information gained from this study was significant in that 15 percent of patients proceeded on to laparoscopic common bile duct exploration. We conclude that intraoperative cholangiogram should be a routine addition to laparoscopic cholecystectomy.