Routine operative cholangiogram?

A controversy exists whether routine operative cholangiography is really necessary or not. The reality is that if don't have practice you cannot do it. And it is the difficult cholecystectomy when you are not entirely sure about the anatomy and when you would feel more confident if you could confirm the integrity of the biliary tree intra-operatively. Finding calculi in the CBD is not actually a purpose of the laparoscopic cholecystectomy for majority of us as many would rather investigate and obtain an ERCP preoperatively if choledocholithisis is suspected and do not have the equipment or motivation to proceed to a laparoscopic exploration of the bile duct if calculi are found incidentally at surgery.
In the settings of a thickened gallbladder wall, dilated and oedematous cystic duct the endoclips may be too short or not strong enough to compress the tissues; this would make the cholangiogram difficult and could result in postoperative bile leak from the cystic duct stump.
A PDS endoloop is an alternative in this situation. The video demonstrates an intra-operative cholangiogram performed with a Concord needle, when the cholangio-catheter is secured temporarily with a PDS endoloop and after the cholangiogram the cystic duct is closed with two PDS endoloops; the author performs routine intra-operative cholangiography and always uses a PDS endoloop on the cystic duct stump with no bile leak to present.

Category:

Science & Technology

Tags:

• Laparoscopy
• visiport
• cholecystectomy
• gallbladder
• gallstones
• bile
• duct
• leak
• injury
• Hasson
• pneumoperitoneum
• cholangiogram
• laparoscopy
• bowel
• obstruction
• laparotomy
• trocar
• insuflation