Routine fluoroscopic cholangiography during laparoscopic cholecystectomy: an argument

We evaluated the impact of routine fluoroscopic cholangiography on our first 100 laparoscopic cholecystectomies. Catheterization of the cystic duct was successfully performed in 89 of 99 attempts. The cholangiogram altered the course of the procedure in 9 (10%) of these cases. In three subjects, the information obtained revealed unsuspected choledocholithiasis. In the remaining six patients, unusual and potentially hazardous anatomic relationships were discovered that were not visible via laparoscopic exposure alone. Arguments for the selective use of cholangiography during open cholecystectomy are based only on the identification of unsuspected stones. The strongest argument for routine cholangiography during laparoscopic cholecystectomy is the additional anatomic information obtained. Based on our experience, we advocate that routine cholangiography be a part of all laparoscopic cholecystectomies.