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Avoiding the Falciform Ligament Sign during the Intraoperative Cholangiogram
obscure the bile ducts making cholangiogram interpretation references
difficult (Figs 1A and 1B). It has been our practice that if this sign
is observed, then the pneumoperitoneum can easily be released 1. Flum DR, Dellinger EP, Cheadle A, et al. Intraoperative cholangiography
and risk of common bile duct injury during cholecystectomy. JAMA
for the purpose of the cholangiogram, without any intraoperative 2003;289:1639–1644. DOI: 10.1001/jama.289.13.1639.
complications. This removes the falciform ligament sign from the 2. Chou P-C, Su Y-J. Falciform ligament sign. N Engl J Med 2017;377:e28.
images, allowing clear cholangiogram images to be seen (Fig. 1C). DOI: 10.1056/NEJMicm1613914.
We feel this is a simple technique that all surgeons could include in 3. Lin J-N. Falciform-ligament sign of pneumoperitoneum. N Engl J Med
their practice during laparoscopic cholecystectomy. 2004;351:e16. DOI: 10.1056/ENEJMicm030659.
World Journal of Laparoscopic Surgery, Volume 14 Issue 2 (May–August 2021) 137
