Expérience de la cholangiographie peropératoire systématique au cours de la cholécystectomie laparoscopique

Abstract

Study aim

The aim of this study was to assess the feasibility of routine intra operative cholangiography during laparoscopie cholecystectomy (LC) and to evaluate its impact in the detection of common bile duct stones or iatrogenic bile duct injuries.

Patients and method

From January 1991 to January 1999, 1,050 patients (mean age: 52,5 years) with symptomatic or complicated cholelithiasis were operated on laparoscopically. Intraoperative cholangiography was attempted in all patients before cholecystectomy, performed with an ureteral catheter (diameter: 5 F) introduced into the cystic duct under control of intensifier screen. In case of detection of common bile duct stones (CBDS) or bile duct injury, a surgical management was routinely attempted laparoscopically.

Results

Cholangiography was successfully performed in 840 cases (82.4%). The mean duration of this examination was 15 min (7–45). The success rate was significantly higher in patients with uncomplicated cholelithiasis (90.4%), compared to patients with acute cholecystitis (61.9%) (p=0.01). The failure rate decreased with experience, falling from 23% for the first 100 attempts to 1% for the last 100. CBDS were identified in 62 patients (7.4%) in 18% of those with acute cholecystitis and 4.6% of those with uncomplicated cholelithiasis. In 21 cases (33%), there were no predictive factors to suggest CBDS.There were 8 false positive (0.9%). Among the 6 cases of bile duct injury observed in this series (0.57%), four patients had an intraoperative cholangiography and the injury was diagnosed peroperatively in two patients and immediately repaired. There was no postoperative death in this series.

Conclusions

Routine intraoperative cholangiography appears to be the best method for the detection of common bile duct stones and improves prognosis of bile duct injuries when they are immediately detected and peroperatively repaired.