Bile duct injury during laparoscopic cholecystectomy without intraoperative cholangiography: a retrospective study on selected patients.

Background: Whether to routinely or selectively use intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) has been a controversial issue for many years. Many authors maintain that IOC decreases the rate of biliary complications such as bile duct injuries, biliary leak, and missed common bile duct (CBD) stones. However, in contrast to these claims, many centers have opted to perform LC without IOC. In this retrospective study, the results of a series of 1,100 LSs, all of which involved major biliary complications and which were performed without the use of IOC, were reviewed. Methods: Data from 1,100 selected patients (/"( femals and £/" males) undergoing LC without the use of IOC from January 2003 to november 2011 were analyzed. One hundred and seventy LCs were performed by young surgeons during learning curve, and 930 by surgeons with over 10 years of experience. Two techniques were used to create pneumoperitoneum: the Verres technique in 319 cases (29%) and Hasson technique in the remaining 781 cases (71%). Patients with a suspicion of CBD stones were excluded from the study. Results: two CBD injuries (0,18%) and three biliary leaks (0,27%) were detected among this group. Thirty-three patients (3%) needed conversion to open cholecystectomy. Missed CBD stones were reported in 4 cases (0,36%). There was no post-operative mortality. Conclusion: LC can be performed safely without the use of IOC and with acceptable low rates of biliary complications. An accurate pre-operative evaluation of clinical risk factors, precise operative procedures, and conversion to an open approach in doubtful cases are important measures wich must be taken to prevenet CBD injury.