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Intraoperative Cholangiography (IOC): Important Aid in Biliary and Common Bile Duct Surgery

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Abstract

Incidence of bile duct injury is documented as high as 3000–3500 patients annually, and occult common bile duct stones occur in up to 12% of patients at time of laparoscopic cholecystectomy. Intraoperative cholangiography is an important aid in biliary surgery in that it allows early identification and repair of common bile duct injury with resulting reductions in morbidity. In addition cholangiography identifies occult common bile duct stones that can be removed by laparoscopic common bile duct exploration resulting in significant cost savings for the patient and the hospital.

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References

  1. Langenbuch C. Ein Fall von Extirpation der Gallenblase wegen chronischer Cholelithiasis. Berl Klin Wochenschr. 1882;19:725.

    Google Scholar 

  2. Kehr H. Practice der Gallenwege – Chirurgie. Munchen: Lehmann; 1913.

    Google Scholar 

  3. Halsted W. Contribution to the surgery of the bile passages, especially of the common bile duct. Johns Hopkins Hosp Bull. 1900;11:1.

    Google Scholar 

  4. Morgenstern L. Halsted’s nemesis: the common bile duct. Surg Endosc. 1994;8:1165–7.

    Article  CAS  PubMed  Google Scholar 

  5. Mayo WJ. Some observations on the surgery of the gallbladder and bile ducts. Ann Surg. 1899;30:452.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Mirizzi PL. La Cholangiografia durante las Operaciones de las vias Biliares. Bol Soc Cir Buenos Aires. 1932;16:1133, pages 5–9.

    Google Scholar 

  7. Hicken NF, Best RR, Hunt HB. Cholangiography. Ann Surg. 1936;103:210., 5–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lackner J, Volkel L. Die Technik der Intraoperative Cholangiographie unter Verwendung des Roentgen-Bildver-staerkers. Roentgenbl. 1957;10:119.

    Google Scholar 

  9. Mallet-Guy P. Television radioscopy during operations of the biliary passages. Surg Gynecol Obstet. 1958;106:747–51.

    CAS  PubMed  Google Scholar 

  10. Berci G, Hamlin JA. Operative biliary radiology, 17 Chapters, 271 pages. Baltimore: Williams and Wilkins; 1981.

    Google Scholar 

  11. Early D. Radiation hazard, Chapter 4. In: Berci H, editor. Operative biliary radiology. Baltimore: Williams & Wilkins; 1981. p. 27–37.

    Google Scholar 

  12. Hamlin JA. Critical analysis, Chapter 17. In: Berci G, Hamlin JA, editors. Operative biliary radiology. Baltimore: Williams and Wilkins; 1981.

    Google Scholar 

  13. Woods MS, Traverso LW, Kozarek RA, Donohue JH, Fletcher DR, Hunter JG, Oddsdottir M, Rossi RL, Tsao J, Windsor J. Biliary tract complications of laparoscopic cholecystectomy are detected more frequently with routine intraoperative cholangiography. Surg Endosc. 1995;9:1076–80.

    Article  CAS  PubMed  Google Scholar 

  14. Madhavan KK, MacIntyre IMC, Wilson RG, Saunders JH, Nixon SJ, Hamer-Hodges DW. The role of intraoperative cholangiography in laparoscopic cholecystectomy. Brit J Surg. 1995;82:249–52.

    Article  CAS  PubMed  Google Scholar 

  15. Muhe E. Laparoscopic cholecystectomy (galloscopy). Langenbuch’s Arch. 1986;369:804.

    Google Scholar 

  16. Dubois F, Berthelot G, Levard H. Cholecystectomie par coelioscopie. La Press Medicale. 1989;18:980–2.

    CAS  Google Scholar 

  17. Perrisat J, Collet D, Belliard R. Gallstones: laparoscopic treatment – cholecystectomy, cholecystostomy, and lithotripsy. Our own technique. Surg Endosc. 1990;4:1–5.

    Article  Google Scholar 

  18. Reddick EJ, Olsen DO. Laparoscopic laser cholecystectomy. A comparison with mini-lap cholecystectomy. Surg Endosc. 1989;3:131–3.

    Article  CAS  PubMed  Google Scholar 

  19. Cuschieri A, Berci G. Laparoscopic biliary surgery. London: Blackwell Scientific Publications, 100 pages; 1990.

    Google Scholar 

  20. Cuschieri A, Berci G, McSherry C. Laparoscopic cholecystectomy (editorial). Am J Surg. 1990;159:273–4.

    Article  CAS  PubMed  Google Scholar 

  21. Sackier J, Berci G. Diagnostic and interventional laparoscopy for the general surgeon. Contemp Surg. 1990;37:14–29.

    Google Scholar 

  22. Berci G, Sackier. The Los Angeles experience with laparoscopic cholecystectomy. J Am J Surg. 1991;161:382–4.

    Article  CAS  Google Scholar 

  23. Sackier JM, Berci G, Phillips E, Carroll B, Shapiro S, Paz-Partlow M. The role of cholangiography in laparoscopic cholecystectomy. Arch Surg. 1991;126:1021–6.

    Article  CAS  PubMed  Google Scholar 

  24. Deziel D, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg. 1993;465:1–6.

    Google Scholar 

  25. Strasberg S, Hertl M, Soper N. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. Am J Surg. 1995;180:101–25.

    CAS  Google Scholar 

  26. Lillemoe K, Martin SA, Cameron JL, Yeo CJ, Talamini MA, Kaushal S, Coleman J, Venbrux AC, Savaderm SJ, Osterman FA, Pitt HA. Major bile duct injuries during laparoscopic cholecystectomies. Ann Surg. 1997;225(5):459–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T. Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA. 2003;289(13):1639–44.

    Article  PubMed  Google Scholar 

  28. Massarweh NN, Flum D. Role of intraoperative cholangiography in avoiding bile duct injury. J Am Coll Surg. 2007;204:656–64.

    Article  PubMed  Google Scholar 

  29. Massarweh NN, Devlin A, Symons RG, Broeckel E, Flum D. Risk tolerance and bile duct injury: surgeon characteristics, risk-taking preference and common bile duct injuries. J Am Coll Surg. 2003;209:17–24.

    Article  Google Scholar 

  30. Soper NJ. Prevention of biliary leaks. Gastrointest Surg. 2011;15:1005–6.

    Article  Google Scholar 

  31. Dageforde LA, Landman MP, Feurer ID, Poulose B, Pinson CW, Moore DE. A cost-effectiveness analysis of Early vs late reconstruction of iatrogenic bile duct injuries. Am Coll Surg. 2012;214(6):919–27.

    Article  Google Scholar 

  32. Schwaitzberg S, Scott D, Jones DB, McKinley SK, Castrillion J, Hunter TD. Three-fold increased bile duct injury rate is associated with less surgeon experience in an insurance claims database. Surg Endosc. 2014;28:3068–73.

    Article  PubMed  Google Scholar 

  33. Stilling NM, Fristrup C, Wettergren A, Ugianskis A, Nygaad J, Holte K, Bardram L, Sall M, Mortensen MB. Long-term outcome after early repair of iatrogenic bile duct injury. A National Danish Multicentre Study. HPB. 2015;17:394–400.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Halbert C, Pagkratis S, Yang J, Meng Z, Altieri MS, Parikh P, Pryor A, Talamini M, Telem DA. Beyond the learning curve: incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era. Surg Endosc. 2016;30:2239–43.

    Article  PubMed  Google Scholar 

  35. Strasberg S, Pucci MJ, Brunt LM, Deziel D. Subtotal cholecystectomy – “Fenestrating” vs “Reconstituting” subtypes and the prevention of bile duct injury: definition of the optimal procedure in difficult operative conditions. J Am Coll Surg. 2016;222(1):89–96.

    Article  PubMed  Google Scholar 

  36. Waage A, Nilsson M. Iatrogenic bile duct injury: a population-based study of 152,766 cholecystectomies in the Swedish inpatient registry. Arch Surg. 2006;40:73–80.

    Google Scholar 

  37. Rystedt J, Lindell G, Montgomery A. Bile duct injuries associated with 55,134 cholecystectomies: treatment and outcome from a national perspective. World J Surg. 2016;40:73–80.

    Article  PubMed  Google Scholar 

  38. Altieri MS Yang J, Obeid N, Zhu C, Talamini M, Pryor A. Bile duct injury and decreasing utilization of intraoperative cholangiogram and common bile duct exploration over 14 years: an analysis of outcomes in New York State. Surg Endosc. 2017;32(2):667–74.

    Article  PubMed  Google Scholar 

  39. Glenn F. Exploration of the common bile duct. Ann Surg. 1940;112(1):64–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Colcock BP, Perey B. Exploration of the common bile duct. Surg Gynecol Obstet. 1964;81:20–4.

    Google Scholar 

  41. Berci G, Hamlin JA. Operative biliary radiology. Baltimore: Williams and Wilkins; 1981.

    Google Scholar 

  42. Wildegans H. Die operative Gallengangsendoskopie. München: Urban & Schwarzenberg; 1960.

    Google Scholar 

  43. Berci G, Cuschieri A. (with 21 Co-contributors)Bile ducts and bile duct stones, 23 Chapters, 169 pages. Philadelphia: Saunders; 1997.

    Google Scholar 

  44. Berci G, Shore JM. Advances in cholangiography. Endoscopy. 1972;4:29–51.

    Article  Google Scholar 

  45. Berci G, Shulman AG, Morgenstern L, Pas-Partlow M, Cuschieri A, Wood RA. Television choledochoscopy. J Surg Gynecol Obstet. 1985;160:176–7.

    CAS  Google Scholar 

  46. Petelin JB. Laparoscopic common bile duct exploration. Surg Endosc. 2003;17:1705–15.

    Article  CAS  PubMed  Google Scholar 

  47. Phillips P, Berci G, Barber K, Williams J. The role of choledochoscopy: the eternal problem of how to remove a CBD stone. Surg Innov. 2015;22(5):540–5.

    Article  CAS  PubMed  Google Scholar 

  48. Phillips E, Berci G, Barber K. The role of the video-choledochoscopy. J Surg Innov. 2016;23:546–9.

    Article  Google Scholar 

  49. Berci G, Morgenstern LM. Laparoscopic management of common bile duct stones. Surg Endosc. 1994;8:1452–3.

    CAS  PubMed  Google Scholar 

  50. Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RCG, Meyers WC, Liguory C, Nickl N. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–93.

    Article  CAS  PubMed  Google Scholar 

  51. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty B, Ryan ME, Shaw MJ, Lande JD, Pheley AM. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335(13):909–18.

    Article  CAS  PubMed  Google Scholar 

  52. Cirocchi R, Kelly MD, Griffiths EA, Tobola R, Sartelli M, Carlini L, Ghersi S, Di Saverio S. A systematic review of the management and outcome of ERCP related duodenal perforations using a standardized classification system. Surgeon. 2017;15:379–87.

    Article  PubMed  Google Scholar 

  53. Urbach DR, Khanjanchee YS, Jobe BA, Standage BA, Hansen PD, Swanstrom LL. Cost-effective management of common bile duct stones. Surg Endosc. 2001;15:4–13.

    Article  CAS  PubMed  Google Scholar 

  54. Strasberg SM, Brunt LM. The critical view of safety. Ann Surg. 2017;265:464–5.

    Article  PubMed  Google Scholar 

  55. Berci G, Hunter J, Morgenstern L, Arregui M, Brunt LM, Carroll B, Edye M, Fermelia D, Gerzli G, Greene F, Petelin J, Phillips E, Ponsky J, Sax H, Schwaitzberg S, Soper N, Swanstrom L, Traverso W. Laparoscopic cholecystectomy: first, do no harm; second, take care of bile duct stones. Surg Endosc. 2013;27:1051–4.

    Article  PubMed  Google Scholar 

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Acknowledgment

We appreciate the work of Marc Arizmendez for video editing contribution to reproduce the figures.

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Correspondence to George Berci .

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Berci, G., Davis, B.R. (2020). Intraoperative Cholangiography (IOC): Important Aid in Biliary and Common Bile Duct Surgery. In: Asbun, H., Shah, M., Ceppa, E., Auyang, E. (eds) The SAGES Manual of Biliary Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-13276-7_8

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  • DOI: https://doi.org/10.1007/978-3-030-13276-7_8

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