Routine Cholangiography During Laparoscopic Cholecystectomy

Albert B. Lowenfels, MD


March 29, 2011

Randomized Clinical Trial of Routine On-Table Cholangiography During Laparoscopic Cholecystectomy

Khan OA, Balaji S, Branagan G, Bennett DH, Davies N
Br J Surg. 2011;98:362-367


Is routine operative cholangiography during gallbladder removal beneficial? In this study, the authors conducted a randomized trial in 190 patients undergoing cholecystectomy. Common duct stones were detected and successfully removed in 3 of 91 patients who underwent routine cholangiography. During the subsequent year, no patients were readmitted for choledocholithiasis. In the control group, 4 patients were readmitted: 1 with a hepatic duct injury and 3 with transient biliary tract obstruction.


Use or non-use of cholangiography during cholecystectomy continues to be controversial. In this trial, which was limited to patients in whom common duct stones were thought to be unlikely, cholangiography added an average of 12 minutes to the operation. However, the overall frequency of untoward postoperative events (eg, prolonged hospitalization or subsequent readmission for biliary tract events) was decreased (3 vs 11, P = .027). This report suggests that the debate about routine cholangiography is still not settled; many surgeons will continue to find routine intraoperative cholangiography helpful.



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