Intraoperative cholangiography for laparoscopic cholecystectomy. 1993

G G Kuster, and S Gilroy, and M Graefen
Department of Surgery, Scripps Clinic and Research Foundation, La Jolla, California 92037.

Intraoperative cholangiography in the course of laparoscopic cholecystectomy is not only valuable to detect common bile duct stones, but also to delineate the anatomy of the biliary ducts, facilitate the dissection, avoid injuries to the biliary tract and identify other abnormalities, such as fistulas, cysts and tumors of the biliary system. Most surgeons use a variation of the transcystic injection of contrast. We describe herein a technique of cholangiography through the gallbladder, performed before starting any dissection in the cystic duct area, which has resulted in a rate of 92 percent of adequate cholangiograms and has proved to be easier, by far, and safer than the transcystic technique. A comparison was made between 405 instances of open cholecystectomies and 200 laparoscopic cholecystectomies with transcystic cholangiograms and 105 laparoscopic cholecystectomies with cholangiograms done through the gallbladder. All instances were done for symptomatic chronic or acute calculous cholecystitis. Satisfactory cholangiograms were obtained in 95 percent of open cholecystectomies and in only 68 percent of transcystic laparoscopic attempts. Complications and false-positive findings were seen in transcystic laparoscopic procedures in five and six instances, respectively. Cholangiography performed through the gallbladder was 100 percent successful among 73 patients with chronic cholecystitis and in 66 percent of 32 patients with acute calculous cholecystitis. For optimal visualization of the bile ducts, it is essential to exert pressure on the gallbladder after the injection of contrast to advance the contrast through the cystic duct. This is greatly facilitated by the use of a double-balloon catheter to avoid leak at the site of the gallbladder puncture.

UI MeSH Term Description Entries
D007430 Intraoperative Care Patient care procedures performed during the operation that are ancillary to the actual surgery. It includes monitoring, fluid therapy, medication, transfusion, anesthesia, radiography, and laboratory tests. Care, Intraoperative
D002404 Catheterization Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from INTUBATION in that the tube here is used to restore or maintain patency in obstructions. Cannulation,Cannulations,Catheterizations
D002758 Cholangiography An imaging test of the BILIARY TRACT in which a contrast dye (RADIOPAQUE MEDIA) is injected into the BILE DUCT and x-ray pictures are taken. Cholangiographies
D002763 Cholecystectomy Surgical removal of the GALLBLADDER. Cholecystectomies
D002764 Cholecystitis Inflammation of the GALLBLADDER; generally caused by impairment of BILE flow, GALLSTONES in the BILIARY TRACT, infections, or other diseases. Empyema, Gallbladder,Gallbladder Inflammation,Empyema, Gall Bladder,Gall Bladder Empyema,Gallbladder Empyema,Inflammation, Gallbladder
D002769 Cholelithiasis Presence or formation of GALLSTONES in the BILIARY TRACT, usually in the gallbladder (CHOLECYSTOLITHIASIS) or the common bile duct (CHOLEDOCHOLITHIASIS). Gallstone Disease,Cholelithiases,Gallstone Diseases
D003549 Cystic Duct The duct that is connected to the GALLBLADDER and allows the emptying of bile into the COMMON BILE DUCT. Cystic Ducts,Duct, Cystic,Ducts, Cystic
D003974 Diatrizoate Meglumine A versatile contrast medium used for DIAGNOSTIC X-RAY RADIOLOGY. Diatrizoate Methylglucamine,Diatrizoic Acid Methylglucamine,Meglumine Diatrizoate,Methylglucamine Diatrizoate,Amidotricoic Acid,Amidotrizoic Acid,Angiografin,Gastrograffin,Gastrografin,Gastrographin,Ioxeol,Meglumine Amidotrizoate,Reno 60,Reno M-Dip,Renograffin,Renografin,Renografin M-76,Sinografin,Triombrast,Triombrin,Urografin,Urografin 76,Urovist,Verografin,Amidotrizoate, Meglumine,Diatrizoate, Meglumine,Diatrizoate, Methylglucamine,Meglumine, Diatrizoate,Methylglucamine, Diatrizoate,Methylglucamine, Diatrizoic Acid,Reno M Dip,Reno MDip,Renografin M 76,Renografin M76
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014283 Triiodobenzoic Acids Triiodo-substituted derivatives of BENZOIC ACID. Triiodobenzoic Acid,Acid, Triiodobenzoic,Acids, Triiodobenzoic

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