Routine Intraoperative Cholangiography During Single-Incision Laparoscopic Cholecystectomy: a Review of 196 Consecutive Patients

Background

Single-incision laparoscopic cholecystectomy (SILC) has been increasingly performed as a potentially less invasive alternative to standard laparoscopic cholecystectomy. However, recent evidences suggest a higher incidence of complications, notably bile duct injuries, in SILC. We reviewed our experiences with routine intraoperative cholangiography (IOC) during SILC to investigate its feasibility and usefulness.

Methods

Among 228 patients who underwent SILC at our institution from September 2009 to July 2012, a total of 196 patients in which an IOC was attempted were retrospectively reviewed.

Results

IOC was successful in 178 of 196 patients, yielding a success rate of 90.8 %. There were no IOC-related complications. Common bile duct (CBD) stones were detected by IOC in 16 patients (8.2 %), all of which were treated by subsequent single-incision laparoscopic CBD exploration or postoperative endoscopic retrograde cholangiopancreatography with stone extraction. In addition, IOC revealed filling defects in the cystic duct (four patients) and poor passage of contrast medium into the duodenum (one patient). In one patient with severe acute cholecystitis, cholangiography via an endoscopic nasobiliary drainage tube revealed misinterpretation of CBD as cystic duct.

Conclusions

We, thus, conclude that routine IOC during SILC is feasible and useful to detect biliary stones and to gain an accurate picture of biliary anatomy.