Role of ultrasound screening for gallbladder disease in pretransplant patients

There is no uniform data regarding prophylactic cholecystectomy in patients undergoing renal transplantation with gallbladder disease. Data analyses suggest that posttransplant patients on cyclosporine have a higher incidence of gallbladder calcifications compared with nonimmunosuppressed patients. Laparoscopic cholecystectomy is a relatively safe procedure in modern-day surgery. Taking these facts into consideration, we attempted to compare risks and complications associated with gallbladder disease and eventual cholecystectomy in pretransplant versus posttransplant patients. Between June 1999 and December 2005, 210 renal transplants were performed at our institution. One hundred four patients who had transplants before April 2003 were not screened for gallbladder disease and nine of these patients developed gallbladder disease. These patients form our control group. One hundred six patients who had transplants after April 2003 had pretransplant screening for gallbladder disease and 11 patients were identified with gallbladder disease. These patients form our study group. Nine patients who developed gallbladder disease after renal transplant underwent laparoscopic cholecystectomy with three resulting morbidities (33%), two graft losses (22%), and one mortality (11%). There was one mortality (11%) in this group. One patient in the study group died of acute gallstone pancreatitis. Of the 11 patients who were found to have gallbladder disease on screening, nine patients underwent laparoscopic cholecystectomy with one morbidity and no mortality or graft loss. Given the relative rarity of the critical events in this study (morbidity, mortality, and graft loss), the definitive statistical value of prescreening for gallbladder disease cannot be established. However, our results are suggestive of clinical value and thus we tentatively recommend ultrasound screening for gallbladder disease for all pretransplant patients and laparoscopic cholecystectomy for those identified to have gallbladder disease.     

Effect of laparoscopic cholecystectomy on gastric emptying and dyspepsia

Background

Laparoscopic cholecystectomy has become the gold standard for treatment of symptomatic gallstone disease. Nonresolution of dyspepsia postoperatively is of major concern nowadays. The present study was conducted to study the effect of laparoscopic cholecystectomy on gastric emptying in symptomatic gallstone disease using ^99mTc sulfur colloid scintigraphy. This pilot study sought to obtain preliminary data and to establish a base for further detailed study.

Methods

A total of 25 patients with a diagnosis of symptomatic gallstone disease scheduled for laparoscopic cholecystectomy were included in the study. All patients underwent gastric scintigraphic emptying study preoperatively and 2 weeks after laparoscopic cholecystectomy. Laparoscopic cholecystectomy was done as a day care procedure.

Results

Mean ± standard deviation preoperative gastric percentage clearance was 51.36 ± 12.67 %. Preoperative gastric emptying half-time was 62.72 ± 21.59 min. Forty percent of patients experienced dyspeptic symptoms before surgery. Twenty-four percent of patients had dyspeptic symptoms during postoperative follow-up at 2 weeks. Postoperative percentage gastric clearance was 49.92 ± 13.17 %. Postoperative gastric emptying half-time was 64.12 ± 19.13 min. Statistical analysis revealed no significant effect of laparoscopic cholecystectomy on gastric emptying parameters.

Conclusions

Laparoscopic cholecystectomy does not alter gastric emptying or stomach percentage clearance in gallstone patients who have preoperative delayed gastric emptying on scintigraphy. Laparoscopic cholecystectomy has no effect on gastric emptying in symptomatic gallstone patients.     

三孔法腹腔镜胆囊切除术1000例治疗体会

目的　探讨三孔法腹腔镜胆囊切除术的可行性。方法　对我院 1 999年 1 0月～ 2 0 0 3年 1 0月 1 0 0 0例三孔法腹腔镜胆囊切除手术进行回顾性分析。结果　三孔法完成手术 96 3例 ,成功率 96 .3%。平均手术时间 4 8min ,平均术中出血 2 5ml,平均住院时间 2 .2d。有 4 3例改行四孔法腹腔镜胆囊切除术。中转手术 4例 ,1例为胆囊结肠瘘 ,3例为急性胆囊炎。胆总管误伤T管引流 1例 ,胆总管电凝伤 3例 ,经鼻胆管引流痊愈。结论　只要采用正确的手术操作方法 ,三孔法腹腔镜胆囊切除术是安全可行的     

Laparoscopic cholecystectomy in patients with a history of gastrectomy

PURPOSE: Previous gastrectomy has been considered a relative contraindication to laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the safety and efficacy of LC in patients with a history of gastrectomy. METHODS: From a database of 1 104 consecutive patients with symptomatic gallstone disease, who underwent LC between April 1992 and January 2007, 51 (4.6%) had undergone previous gastrectomy: for gastric cancer (n = 36) or gastroduodenal ulcer (n = 15). We compared the operative time, blood loss, conversion rate, morbidity rate, diet resumption, and postoperative hospital stay between patients with, and those without, a history of gastrectomy. RESULTS: The incidence of common bile duct stones was significantly higher (33.3% vs 8.6%, P < 0.001) and operative time was significantly longer (111.2 min vs 77.9 min, P < 0.001) in the patients with a history of gastrectomy. There was no significant difference in operative time between the first-half and second-half periods. Conversion to an open cholecystectomy was required in two patients. There was no significant difference between the two groups in blood loss, conversion rate, morbidity rate, diet resumption, or postoperative hospital stay. CONCLUSION: Laparoscopic cholecystectomy is a safe and effective treatment for symptomatic gallstone disease in patients with a history of gastrectomy, although previous gastrectomy is associated with an increased need for adhesiolysis and a longer operative time.     

终末期肾病及肾移植患者胆囊病变的外科治疗

目的　探讨终末期肾病及肾移植患者胆囊病变的发病率和胆囊切除术的指征、手术时机、手术方法。方法　回顾性分析 2 0 0 0年 4月～ 2 0 0 4年 3月间 2 86例终末期肾病及肾移植患者胆囊病变的发病情况 ,所有患者均进行 1次或数次B超检查。结果　 3 2例患者发现有胆囊病变 ,发病率为 11.2 % ( 3 2 /2 86) ,其中胆囊结石 2 0例 ( 62 .5 % ) ,胆泥 6例 ( 18.8% ) ,胆囊息肉样病变 6例( 18.8% )。 2 0例合并有慢性胆囊炎症状的受者于移植前行胆囊切除 ,其中 14例行腹腔镜胆囊切除(LC) ,6例行小切口胆囊切除 (MC ) ;12例无症状的受者于移植前、后行预防性LC 5例 ,余 7例无症状者肾移植术后 6个月内并发急性胆囊炎 3例 ,均行急诊LC ,1例中转开腹手术。全组无手术死亡及移植肾功能丧失。结论　终末期肾病及肾移植患者的胆囊病变以胆囊结石为主 ,发病率与正常人群相似。对合并有慢性胆囊炎症状的受者于移植前行胆囊切除是必要和安全的 ,手术方式首选LC ,对无症状的受者推荐于移植前或急性胆囊炎发作前行LC。     

Pancreatic injury: an unusual complication of laparoscopic cholecystectomy

Laparoscopic cholecystectomy is a popular method for managing symptomatic gallstone disease. Decreased morbidity and mortality rates make this procedure an attractive alternative to conventional cholecystectomy. However, unusual complications still occur. We report a case of pancreatic injury that occurred during laparoscopic cholecystectomy. The case was complicated with posttraumatic pancreatic inflammation and bowel necrosis.     

Evaluation of routine upper digestive tract endoscopy before laparoscopic cholecystectomy.

Endoscopy of the upper digestive tract was performed in 376 patients with symptomatic gallstone disease before elective laparoscopic cholecystectomy. Abnormalities were found in 60 patients (16.0 per cent); these included peptic ulcer (n = 14), gastric erosions (n = 15) and oesophagitis (n = 11). Thirty patients were treated medically and two by endoscopic polypectomy. In four patients endoscopy led to cancellation of cholecystectomy; in two the complaints have persisted. Statistical analysis of 28 variables showed few significant differences in symptoms between patients with normal and those with abnormal appearances at endoscopy. It is concluded that routine endoscopy before laparoscopic cholecystectomy is neither clinically useful nor cost effective in patients with symptomatic gallstone disease. This conclusion is related exclusively to patients with typical gallstone symptoms according to the definition used in this department.     

Laparoscopic cholecystectomy in pancreas transplant recipients

Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Since its introduction in 1987, this procedure has been employed with increasing frequency as its safety has been documented in numerous studies. Absolute contraindications to laparoscopic cholecystectomy have become relative contraindications, and patients previously felt to be at excessive risk for laparoscopic cholecystectomy are viewed as patients who may benefit from laparoscopic cholecystectomy. The use of this procedure in patients with comorbid medical conditions has the potential to decrease patient morbidity. Patients who have previously undergone solid organ transplantation and require immunosuppressive therapy are a group of patients who may benefit from laparoscopic cholecystectomy. We report four patients who have previously undergone combined renal and pancreas transplantation who underwent successful laparoscopic cholecystectomy.     

Laparoscopic cholecystectomy in cirrhotic patients with symptomatic gallstone disease

Background: The aim of this study was to evaluate the outcome in patients with liver cirrhosis who underwent laparoscopic cholecystectomy for symptomatic gallstone disease. Methods: Retrospective analysis of prospectively collected data of 34 patients operated between March 1998 and April 2006. Results: There were 19 male and 15 female patients with a median age of 62 years. Cirrhosis aetiology was viral hepatitis in 25 patients, alcohol in 6, primary biliary cirrhosis in 2 and in 1 patient the cause was not identified. Twenty‐three were classified as Child–Pugh–Turcotte stage A and 11 as Child–Pugh–Turcotte stage B. The median Model For End‐Stage Liver Disease score was 12. Median operating time was 96 min. In three patients there was conversion to open cholecystectomy. Postoperatively, one patient died and six more patients had complications. Median postoperative stay was 3 days. Patients with acute cholecystitis did not have increased morbidity, but had significantly longer hospital stay. Conclusion: Laparoscopic cholecystectomy can be carried out with acceptable morbidity in selected patients with well‐compensated Child A and B stages liver cirrhosis. Patients with evidence of significant portal hypertension and severe coagulopathy should avoid surgery.     

Symptomatic gallstones after sleeve gastrectomy

Background

Cholelithiasis is a common complication after bariatric surgery. Pure restrictive procedures such as sleeve gastrectomy and gastric banding theoretically should result in less gallstone formation because the food continues to follow the normal gastrointestinal transit, maintaining the enteric–endocrine reflex intact. To the authors’ knowledge, the literature has no studies that analyze the incidence of gallstone formation after sleeve gastrectomy. This study aimed to compare the rates of symptomatic gallstones between laparoscopic Roux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG).

Methods

A retrospective chart review of patients who underwent laparoscopic RYGBP and SG between 2004 and 2006 was performed. The patients with previous cholecystectomy, known gallstones with or without concomitant cholecystectomy, and previous weight-reduction operations were excluded from the analysis. The outcome measures were the numbers of patients who had experienced symptomatic and complicated gallstones. Using Cox regression analysis, comparisons was made between the patients with laparoscopic RYGBP (group A) and those with laparoscopic SG (group B).

Results

Groups A excluded 174 (26%) of 670 patients, and group B excluded 27 (34.2%) of 79 patients. The patients in group A had a significantly higher preoperative body mass index (BMI) than those in group B. Additionally, more group A than group B patients had a BMI exceeding 45 and more than a 25% loss of original weight. No significant difference in the development of symptomatic (8.7% vs. 3.8%; p = 0.296) or complicated (1.8% vs. 1.9%; p = 0.956) gallstones was noted between the two groups

Conclusions

There was no significant difference in symptomatic or complicated gallstone disease between the patients treated with laparoscopic SG and those treated with laparoscopic RYGBP. Routine prophylactic cholecystectomy should not be recommended for weight reduction during laparoscopic SG.     

Gallstone disease in heart transplant recipients

OBJECTIVE: To review the outcome of cholecystectomy after heart transplant. SUMMARY BACKGROUND DATA: The optimal timing for gallbladder surgery in heart transplant patients is controversial. METHODS: Between April 1985 and October 2000, 518 cardiac transplants were performed at Ochsner Foundation Hospital. Data gathered included ultrasound reports, cholecystectomy operative reports, gallbladder pathologic reports, complications, and deaths. RESULTS: Charts were available for 509 patients (98%), 68 (13%) of whom underwent cholecystectomy before transplantation. Of the 509, 53 (10%) had serial ultrasound examinations and 29 of the 53 (55%) developed gallstones. After transplant, 47 (9%) underwent cholecystectomy. Five cholecystectomies were performed during the immediate postoperative course. Two patients who underwent cholecystectomy had acalculous cholecystitis; one was incidental. Four patients died (one with rejection and three with sepsis). After discharge, 42 cholecystectomies were performed: 16 for biliary colic (no deaths, three patients with complications), 19 for acute cholecystitis (one death, nine patients with complications), 5 for biliary pancreatitis (1 death, 1 patient with complications), and 2 others. CONCLUSIONS: The risk of morbidity and mortality from gallstone disease is high in cardiac transplant patients, particularly immediately posttransplant. Posttransplant patients require annual ultrasound examinations to detect the onset of gallstone disease, and this risk is higher than in the general population. Gallstones alone are an indication for cholecystectomy in the cardiac transplant patient. Pretransplant cholecystectomy should be considered in clinically stable patients with gallstones.     

Changing management of gallstone disease during pregnancy

Background: Symptomatic gallstones may be problematic during pregnancy. The advisability of laparoscopic cholecystectomy (LC) is uncertain. The objective of this study is to define the natural history of gallstone disease during pregnancy and evaluate the safety of LC during pregnancy. Methods: Review of medical records of all pregnant patients with gallstone disease at the University of California, San Francisco, from 1980 to 1996. Results: Of approximately 29,750 deliveries, 47 (0.16%) patients were treated for gallstone disease, including biliary colic in 33, acute cholecystitis in 12, and pancreatitis in two. Conservative treatment was attempted in all patients but failed in 17 (36%) cases. Two patients required combined preterm Cesarean-section cholecystectomy and 10 required surgery in the early postpartum period for persistent symptoms. Seventeen patients required cholecystectomy during pregnancy for biliary colic (10), acute cholecystitis (six), and pancreatitis (one). Three patients were treated with open cholecystectomy. Fourteen patients underwent LC at a mean gestational age of 18.6 weeks, mean OR time of 74 min, and mean length of stay of 1.2 days. Hasson cannulation was utilized in 11 patients. Reduced-pressure pneumoperitoneum (6–10 mmHg) was used in seven patients. Prophylactic tocolytics were used in seven patients, with transient postoperative preterm labor observed in one. There were no open conversions, preterm deliveries, fetal loss, teratogenicity, or maternal morbidity. Conclusions: In past years, symptomatic gallstones during pregnancy were managed conservatively or with open cholecystectomy. LC is a feasible and safe method for treating severely symptomatic patients. Received: 3 April 1997/Accepted: 5 July 1997     

Long-term results after laparoscopic cholecystotomy in a child with symptomatic gallstone disease

Cholecystotomy has been suggested for symptomatic gallstone disease in selected children. This suggestion is supported by a potential reduction in the frequency of the so-called postcholecystotomy syndrome. To our knowledge, laparoscopic cholecystotomy has not been reported yet. However, gallstone recurrence has been reported up to 4 years after conventional cholecystotomy and therefore we waited to publish our results for that period of time. A 12-year-old girl with idiopathic symptomatic gallstone disease and a normal kinetic of the gallbladder underwent laparoscopic cholecystotomy. The laparoscopic technique was similar to laparoscopic cholecystectomy but the gallbladder was left in place and multiple gallstones were removed. Intraoperative cholecystoscopy revealed three additional small stones. They were removed by subsequent lavage of the gallbladder. Choledocholithiasis was excluded by intraoperative cholangiography and the gallbladder was closed using an Endo GIA. There were no intraoperative or postoperative events. The patient is free of complaints without recurrent gallstones on ultrasound examination today, 4 years after the operation. Laparoscopic cholecystotomy represents a feasible alternative to laparoscopic cholecystectomy. Received: 10 May 1996/Accepted: 29 May 1996     

Laparoscopic cholecystectomy and interventional endoscopy for gallstone complications during pregnancy

Background: Symptomatic or complicated gallstone disease is the most common reason for nongynecological operations during pregnancy. Gallstones are present in 12% of all pregnancies, and more than one-third of patients fail medical treatment and therefore require surgical endoscopy or laparoscopy. Gallstone pancreatitis and jaundice during pregnancy is associated with a high recurrence rate, exposing both fetus and mother to an increased risk of morbidity and mortality. Methods: During a 4-year period, all pregnant patients (n= 37) with symptomatic or complicated gallstone disease were studied prospectively at the Landeskrankenhaus in Salzburg, Austria. Five patients had an endoscopic retrograde cholangiopancreatogram (ERCP) for biliary pancreatitis or jaundice; two of these underwent subsequent laparoscopic cholecystectomy. Another seven patients required laparoscopic cholecystectomy for severe pain or cholecystitis; all were in their 13th–32nd gestational week. Access was established by Veress needle in all cases. Insufflation pressure was 8–10 mmHg, and mean operative time was 62 min. Results: All patients delivered full-term, healthy babies. There were no postendoscopic or postoperative complications. All patients enjoyed full relief from their symptoms; there were no recurrences of pancreatitis or jaundice. Conclusions: The combination of ERCP and laparoscopic cholecystectomy offers a safe and effective option for the definitive treatment of complicated gallstone disease and intractable pain during pregnancy, and there is sufficient access for the combined treatment to be employed. Received: 7 September 1998/Accepted: 2 June 1999     

Laparoscopic cholecystectomy in cirrhotic patients

Liver cirrhosis is considered a contraindication to laparoscopic cholecystectomy for the moment. Here we are reporting on results in the surgical treatment of gallstone disease in cirrhotic patients by laparoscopic means. We reviewed the experience over the final period of time in 11 patients since the introduction of laparoscopic procedures in our unit. The index of conversion rate was 9.1% (1/11). The morbidity was nil. The average length of hospital stay was 1.8 days (1–6 days). We propose the use of laparoscopic cholecystectomy in gallstone disease in patients with liver cirrhosis as first-line surgical treatment.     

Asymptomatic gallstones in the laparoscopic era

Recent introduction of new treatment options has significantly altered the approach towards gallstone management. There is now general agreement that cholecystectomy is the treatment of choice for symptomatic gallstones. Controversy, however, exists as to the management of asymptomatic gallstones. The ready availability of abdominal ultrasonography for the investigation of a wide range of abdominal symptoms has resulted in the increased diagnosis of asymptomatic gallstones. Management of such accidentally discovered gallstones poses a dilemma as conclusive evidence of the benefits of cholecystectomy is lacking. This is further complicated by the fact that the majority of asymptomatic gallstones remain so and patients rarely experience symptoms or complications. Furthermore, cholecystectomy is associated with a low but recognised morbidity. Recent introduction of laparoscopic cholecystectomy as the treatment of choice of symptomatic gallstones has further complicated the issue of asymptomatic gallstone management. This article reviews the current management of asymptomatic gallstones in the era of laparoscopic cholecystectomy     

Outcomes of Laparoscopic Cholecystectomy in Octogenarians

Background and Objectives:

Extremely elderly patients usually present with complicated gallstone disease and are less likely to undergo definitive treatment. The purpose of this study was to evaluate the results of laparoscopic cholecystectomy in octogenarians, with an interest in patients presenting initially with complicated gallstone disease and pancreatitis who underwent laparoscopic cholecystectomy during the same hospitalization.

Methods:

Data for 42 patients ≥80 years who underwent an elective laparoscopic cholecystectomy between January 2007 and August 2011 were retrospectively reviewed. Indications for the procedure were stratified into 2 groups: Outpatients, who were admitted electively to undergo cholecystectomy, and Inpatients, who came to our Emergency Room due to complicated biliary diseases. Data analysis included age, sex, ASA score, conversion to open surgery, time spent under general anesthesia, and length of hospital stay.

Results:

Mean age was 83.9 years; 19 (45.2%) were men. Thirteen patients (30.9%) were in the outpatient group, and 13 (30.9%) had a preoperative ASA of 3. Fourteen patients (33.3%) needed ICU. Two patients (4.8%) had their surgery converted. There were 7 (16.7%) postoperative complications, all of them classified as Dindo-Clavien I or II. No differences were noted between groups regarding conversion rates or complications. We had no mortalities in this series. There was no difference in hospital length of stay between the groups.

Conclusion:

Laparoscopic cholecystectomy in the extremely elderly is safe, with acceptable morbidity. Patients with complicated gallstone disease seem not to have worse postoperative outcomes once the initial diagnosis is properly treated and would benefit from definitive therapy during the same hospitalization.     

Laparoscopic or open conventional cholecystectomy: clinical and economic considerations.

OBJECTIVE: To compare clinical aspects and financial costs of open conventional and laparoscopic cholecystectomy. DESIGN: Retrospective analysis of hospital records of patients who were operated on electively for symptomatic gallstone disease. SETTING: University clinic, Germany. SUBJECTS: 153 consecutive patients who had open conventional (1991-92) and 222 who had laparoscopic cholecystectomy (1993-96). A total of 251 cholecystectomies were done during 1991-92 and 523 cholecystectomies during 1993-96. Intervention: Cholecystectomy. MAIN OUTCOME MEASURES: Clinical aspects: operating time, complications, postoperative stay; financial aspects: total cost of hospital stay after cholecystectomy. RESULTS: When open conventional was compared with laparoscopic cholecystectomy: operating time was 66 and 92 minutes; complications, 9 and 6 cases; postoperative stay, 8 and 3 days; and total cost of hospital stay, US $ 3434 and US $ 2808 respectively. CONCLUSION: The cost of laparoscopic cholecystectomy was 18% less than for open conventional cholecystectomy, principally because of the shorter postoperative stay.     

Symptomatic gallstones in patients with spinal cord injury

Patients with spinal cord injury (SCI) have an increased prevalence of cholelithiasis. The goal of this study was to clarify the presentation and management of symptomatic gallstone disease in patients with SCI. We performed a retrospective study of presentation of gallstone complications in patients with SCI who underwent cholecystectomy for complications of gallstone disease. The West Roxbury Veterans Administration Medical Center SCI registry (605 patients) was searched for patients who had undergone cholecystectomy more than 1 year after SCI (35 patients). Gallbladder disease profiles for the 35 patients undergoing cholecystectomy for complications of gallstone disease were prepared, including demographics, clinical presentation, diagnostic studies, operative and pathologic findings, and postoperative complications. All patients were white. Thirty-four were male and the mean age was 50 years (range 35 to 65 years). The majority of patients (66%) complained of right upper quadrant abdominal pain, even those patients with SCI at high (i.e., cervical) levels. Of the 35 patients in our study group, 22 (63 %) had biliary colic and chronic cholecystitis, nine (26%) had acute cholecystitis (gangrenous cholecystitis in two), two (6%) had choledocholithiasis symptoms or cholangitis, and two (6%) had gallstone pancreatitis. Major perioperative morbidity occurred in two (6%) of the 35 patients (pulmonary embolus; intraoperative hemorrhage), and there were no deaths. In the great majority of patients with SCI, cholelithiasis presents with chronic pain and not with life-threatening complications. Our findings suggest that presentation is no more acute in patients with SCI than in the general population. Characteristic symptoms and signs are not necessarily obscured by SCI injury, regardless of the level.     

Selective intraoperative cholangiography during laparoscopic cholecystectomy: how selective?

The necessity for intraoperative cholangiography during laparoscopic cholecystectomy has been debated for some time. Numerous retrospective studies favor selective intraoperative cholangiography. Surgeons in favor of the selective policy differ in their personal selective criteria. The aim of this prospective study was to evaluate whether intraoperative cholangiography can be safely omitted during laparoscopic cholecystectomy on all patients who fit a standard set of criteria: normal liver function tests, common bile duct diameter less than 10 mm, and no history of gallstone pancreatitis or jaundice. We undertook a prospective study on 155 consecutive patients treated in a county teaching hospital with symptomatic gallbladder disease who met the above standard set of criteria. One hundred and fifty-five patients meeting these criteria underwent laparoscopic cholecystectomy during a 2-year period from February 1996 through February 1998. Data analyzed included patient history, laboratory and ultrasound findings, operative results, postoperative stay, and intraoperative and postoperative complications. The patients were followed by periodic interviews, physical examination, liver function tests, and/or biliary ultrasound for up to 3 1/2 years with a mean follow-up of 26 months for retained common bile duct stones. Intraoperative cholangiography was performed in only one of the 155 patients studied to confirm common bile duct injury. There were four postoperative complications (2.6%) and one common bile injury (0.6%). Postoperative stay averaged one day. No patients, by history, biliary ultrasound, liver function tests or endoscopy, were found to have retained common bile duct stones during the follow-up period. Our study shows that intraoperative cholangiography is not necessary for patients undergoing laparoscopic cholecystectomy who have normal liver functions tests, common bile duct diameter less than 10 mm, and no history of gallstone pancreatitis or jaundice.