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WJOLS
Bile Duct Injury in Laparoscopic Cholecystectomy without On-table Cholangiography
ORIGINAL ARTICLE
Bile Duct Injury in Laparoscopic

Cholecystectomy without On-table

Cholangiography

1 2 3 4 5
Mohammad Zarin, Mujeeb-Ur-Rehman, Shehzad Akbar, Usra Ahmed, Mansoor Khan
6 7 8
Rooh-Ul-Muqim Aziz Wazir, Muhammad Salman
1
Assistant Professor, Department of Surgery (Surgical “C” Unit), Khyber Teaching Hospital, Peshawar, Pakistan
2,5,8 Resident, Department of Surgery (Surgical “C” Unit), Khyber Teaching Hospital, Peshawar, Pakistan
3
Assistant Professor, Khyber Girls Medical College, Peshawar, Pakistan
4
House Officer, Khyber Teaching Hospital, Peshawar, Pakistan
6 Associate Professor, Department of Surgery (Surgical “C” Unit), Khyber Teaching Hospital, Peshawar, Pakistan
7
Professor, Department of Surgery (Surgical “C” Unit), Khyber Teaching Hospital, Peshawar, Pakistan
Correspondence: Mohammad Zarin, Assistant Professor, Department of Surgery (Surgical “C” Unit), Khyber Teaching Hospital
Room No. 86, Old Doctor’s Hostel, Peshawar, Pakistan, Phone: 03339414477, e-mail: drmzareen@yahoo.co.uk

Abstract
Objective: To determine the safety of laparoscopic cholecystectomy without On-table cholangiography.
Study design: Quasi-experimental study.
Setting and duration: Surgical “D” ward Khyber teaching hospital Peshawar from January 2005 to December 2008.
Methodology: Patients of acute or chronic cholecystitis due to gallstones were included in this study while patients of obstructive
jaundice and gallbladder mass were excluded. All patients were operated through laparoscopic cholecystectomy without On-table
cholangiography. During procedure, bile duct injury were noted and evidences of bile duct injury were also collected postoperatively
during hospitalization and follow-up visits. Data regarding complications in terms of bile duct injury were recorded and analyzed.
Results: A total of 7 (0.92%) bile duct injuries were noted in this series. There were two (0.26%) cases of partial injury to the common
hepatic duct out of which 1 was a case of Mirizzi’s syndrome. In the second case, a partial injury to the common hepatic duct occurred
during an attempt to cauterize the avulse branch of cystic artery. In two (0.26%) patient’s partial injury to common bile duct occurred due
to tenting of common bile duct. Complete transaction of common bile duct occurred in two (0.26%) cases. In one (0.13%) patient post-
operative leakage was found to be due to severed cholecystohepatic duct.
Conclusion: The results clearly show that there is hardly any difference as far as the CBD injury is concerned with or without On-table
cholangiography, provided we have a good back-up by a radiologist for pre- and postoperative ultrasound and ERCP.
Keywords: Laparoscopic cholecystectomy (LC), common bile duct (CBD), On-table chalangiogram (OTC), ultrasonography (USG).

INTRODUCTION stones and thus reducing the incidence of unnecessary CBD
exploration from 66% to < 5%. 5 In cholecystectomy, the
The introduction of laparoscopic cholecystectomy has routine use of OTC is controversial as it is useful to map
increased bile duct injuries by three to four folds. 1,2 Bile the anatomy of the biliary tree but on the other hand it
duct injury can lead to bile leakage, peritonitis, stricture increases the operation time, cost and unnecessary CBD
formation, cholangitis, jaundice, chronic liver disease and exploration due to poor quality images and false-negative
and false-positive results. The debate becomes further
septicemia. These injuries are frequently amenable to delayed
complicated with the advent of laparoscopic cholecystec-
recognition and difficult reoperations due to inflammation, 6
tomy which demands additional technical skills for OTC.
3
infection and malnutrition. A number of techniques have
Numerous studies have shown that Laparoscopic chole-
been devised to prevent such injuries and among these On- cystectomy was performed safely with minimal use of
table cholangiography (OTC) is widely practiced. On-table OTC. While others insist the routine use of OTC during
7,8
cholangiography (OTC) was first recommended by Mirizzi 4 laparoscopic cholecystectomy to minimize the CBD in-
in 1931 on the basis of high incidence of common bile duct juries. 9-11
World Journal of Laparoscopic Surgery, January-April 2010;3(1):41-44 41