Despite the usefulness of the intraoperative cholangiography(IOC), the role of routine IOC has been debated. We reviewed the indication of laparoscopic cholangiography and the value of DISIDA scan in the laparoscopic cholecystectomy. We adopted a
policy
of selective IOC. The indication of IOC included elevated total bilirubin(>1.2mg/dl), delayed biliary enteric transit time in DISIDA scan(>1hr), suspected choledocholithiasis by US but not performing cholangiography, dilated cystic duct(above
8mm),
or
common bile duct (above 12mm) in operating field.
Thirty one(4.6%) operative cholangiograms were obtained in 681 patients who underwent laparoscopic cholecystectomy from March 1992 to March 1996. Of 31 patients undergoing laparoscopic cholangiography, 11(35%) had abnormal cholangiogram. 8 of 11
had
proven common bile duct stones. Of 13 patients in delyed DISIDA scan alone, 2 had abnormal cholangiogram, Only one patient had proven CBD stone. Of 9 patients in delayed DISIDA scan with suspected CBD stone by US, or elevated total bilirubin, 4
had
abnormal cholangiogram, and all had proven CBD stone. Of 9 patients who was suspected CBD stone by US, 7 had abnormal cholangiogram, Of these 7 CBD stones were noted in all patients. 12 patients with elevated serum bilirubin had 5 abnormal
cholangiogram, 3 out of 5 had CBD stone.
We can not make a confirmed conclusion because our case lacked sufficient quantity for effectiveness. But laparoscopic operative cholangiography could be performed selectively in the case of which suspected choledocholithiasis by US, and delayed
biliary
enteric drainage in DISIDA scanning without another criteria is not indicated IOC.
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