Diagnostic accuracy of intraoperative cholangiography for detection of anatomical variations of the biliary system

Introduction
Intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is valuable in the detection of biliary abnormalities. In this study, we aimed to investigate the diagnostic accuracy of IOC during LC for the detection of anatomic variations of the biliary system, as well as the visualization ability of IOC on determining the normal anatomy of the biliary tree.
Patients and methods
A total of 56 patients, admitted with symptomatic gall stones, who met our inclusion criteria were involved in this prospective randomized study. LCs with cholangiograms were performed by a laparoscopic surgeon and reviewed by a radiologist and were carried out by using a standard four-cannula technique.
Results
Overall, 68% of patients were females, and their mean age was 42±10 years. There were 21 patients known to have different chronic illnesses, including hypertension (14%), diabetes mellitus (12%), chronic liver disease (7%), and ischemic heart disease (4%). Regarding the results of preoperative ultrasound, approximately two-thirds of patients had normal ultrasound, whereas the other one-third had dilated intrahepatic biliary duct (13%) and common bile duct sludge (16%). Residency was statistically significant with presence of stones (=0.007). Visualization ability of IOC achieved 100% visualization rate for the whole 54 cases that underwent IOC. Failure rate of IOC was 4%, and failure was attributed mainly owing to technical errors or narrowing of cystic duct in two cases per each.
Conclusion
The results of the current study encourage using IOC as an effective, accurate, feasible, and safe technique to visualize the biliary tree while performing LC.