Adithya G.K.1, Satya Prakash Jindal2, Varun Madaan3, Vachan Hukkeri4, Rigved Gupta5, Vivek Tandon6, Deepak Govil7
BACKGROUND
Intra-Operative Cholangiogram (IOC) is a procedure carried out during
cholecystectomy with the primary objective of clearly delineating the biliary
anatomy. Over decades, routine IOC became selective IOC and now it is being
overtaken by less invasive investigations like MRCP and EUS. Role of IOC remains
only to intraoperatively confirm or rule out bile duct injury in difficult cases.
Laparoscopic IOC is a skilful procedure which requires training and extra added
time during laparoscopic cholecystectomy. Once mastered it can be used in many
situations for either anatomical reasons or to detect CBD pathology.
METHODS
All patients getting admitted for laparoscopic cholecystectomy with intermediate
risk for choledocholithiasis were enrolled in the study from 2016 to 2019.
Procedure was carried out with all necessary consents and precautions. All cases
were performed by an experienced GI surgeon and followed up with proper
protocol.
RESULTS
Fifty patients with known intermediate risk for choledocholithiasis underwent
laparoscopic cholecystectomy with laparoscopic IOC. Procedure was successfully
done in all patients except two, where cystic duct was very thin and cannulation
was not possible. Forty-one (82%) patients had deranged liver function test and
9 patients (18%) had history of acute pancreatitis in the past as indications for
the procedure. Two patients had dilated CBD (>6 mm) on ultrasound along with
deranged liver function tests. An average of 12 minutes was taken to perform the
procedure (range: 8 - 15 min). In cases where IOC took longer time was mainly
due to technical issues (operability of C-arm). No IOC related complications
occurred in any of the patients. Hospital stay was not prolonged in any of the
patients due to IOC. None of the patients had any filling defect in CBD. All cases
followed till date are asymptomatic.
CONCLUSIONS
It is a technically feasible procedure that can be performed with limited addition
to OT time, minimal failure rate, and complications. All patients with limited criteria
for intermediate risk of choledocholithiasis had a normal IOC with no evidence of
biliary obstruction in follow up.
