[Role of cholangiography in laparoscopic cholecystectomy]

Abstract

Cholangiography in laparoscopic cholecystectomy is indicated for the detection of bile duct stones and for visualization of the biliary anatomy in particular cases. For a selective approach patients with gallbladder stones can be split into groups with a low, an intermediate and a high probability of choledocholithiasis by use of ultrasonographic and laboratory parameters. In this respect, the choledochal diameter is the most accurate criterion for the prediction of duct stones. A narrow lumen, detectable in almost one-half of the patients, indicates a less than 4% incidence of duct stones. Cholangiography seems to be unnecessary in this low risk group. However, endoscopic retrograde cholangiography (ERC) or intraoperative cholangiography is indicated in patients with a 7-12 mm width of common bile duct and/or an elevated serum bilirubin level due to 10-50% risk of choledocholithiasis. There are several therapeutic options in case of detected duct calculi. To date, laparoscopic bile duct clearance can not be reliably performed. In about 15% of the patients an even larger choledochol diameter is associated with a high chance of bile duct stones. ERC and in case of detected stones endoscopic papillotomy (EPT) should be routinely performed in these patients to facilitate elective laparoscopic cholecystectomy.