Background and Study Aims: One reason why
many surgeons do not attempt laparoscopic cholangiography is that it is considered
to be technically difficult and to produce poor-quality images.
Patients and Methods: A retrospective comparison
was made of twenty randomly selected intraoperative cholangiograms taken during
laparoscopic cholecystectomy for each year from 1991 to 1994 (n = 80)
by assigning a score (0 - 4) on the basis of anatomical
parameters and radiographic quality. Twenty randomly selected intraoperative
cholangiograms taken during open cholecystectomy (OC) were used as controls.
Results: The average score for the laparoscopic
cholangiograms (LCs) was significantly lower than the average for OC cholangiograms
(2.3 vs. 3.4, P < 0.001). In
addition, a learning curve was demonstrated, which showed significant improvement
in the quality of LCs over the years. Analysis showed that in LCs, only 34 %
succeeded in demonstrating the entire biliary tree and only 49 % managed
to show the extrahepatic duct system. Choledocholithiasis could only be ruled
out in 53 % of LC films, compared with 80 % of controls.
Conclusions: Despite an improvement
in the quality of laparoscopic cholangiography, it remains inferior to cholangiography
during open cholecystectomy. Recommendations are made regarding ways in which
improvements could be achieved.
