La colangiografia intraoperatoria in corso di colecistectomia videolaparoscopica: quale ruolo? Risultati di uno studio non randomizzato


COD: 085-090 Categorie: ,

Antonio Ciulla, Giuseppe Agnello, Giovanni Tomasello, Gioacchino Castronovo, Alfonso Maurizio Maiorana, Gaspare Genova

Ann. Ital. Chir., 2007; 78: 85-89

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INTRODUCTION: The routine use of intraoperative cholangiography during laparoscopic cholecystectomy remains controversial.
Mirizzi was the first to recommend the use of intraoperative cholangiography in 1931 based on the high incidence of
unsuspected common bile duct stones.
The use of intraoperative cholangiography before common bile duct exploration reduced the incidence of unnecessary common
bile duct explorations from 66% to less than 5%.
With the intoduction of laparoscopic cholecystectomy, an increase of incidence of bile duct injury two to four times that
seen in open cholecystectomy was witnessed. The vast majority of the injuries were a direct result of the surgeon
misidentifying the anatomy. The Authors report their experience in the use of intraoperative cholangiography to prevent bile duct injuries and to
discover common bile duct unknown lithiasis.
METHODS: From December 2002 to January 2004 in 169 patients affected to cholecystolithiasis were undergone cholecystectomy.
During this operation intraoperative cholangiography was performed routinely. The patients were divided in
two groups. In the Group A the patient with high risk according to a score system. and the others in the group B.
RESULTS: The cholangiography was performed with success in the 97% of patients.
It were discover common bile duct in the 17%, biliary anatomy anomalies in the 3.5%, bile duct injuries in the 0.5%
and false positive in the 2.9%.
CONCLUSION: The Authors recommended the routinely use of intraoperative cholangiography owing to its a feasible and
safe technique with a success rater greater than 90%. If a bile duct injury is going to occur because of misidentification,
cholangiography will not prevent the injury, but a properly performed cholangiogram will minimize the extent of
the injury. Finally, the intraoperative cholangiography can discover a common unknown bile duct lithiasis and can reduce incidence
of unnecessary ERCP with subsequent complication.