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Routine Cholangiography During Laparoscopic Cholecystectomy

Danny V. Cantwell, MD
Arch Surg. 1992;127(4):483-484. doi:10.1001/archsurg.1992.01420040129023.
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Laparoscopic cholecystectomy is now the accepted procedure of choice for removal of the gallbladder. The performance of routine intraoperative cholangiography during open cholecystectomy is controversial,1,2 and the debate continues with regard to the laparoscopic approach.3 Cholangiography has been advocated to diagnose choledocholithiasis and to clarify the ductal anatomy.4 A case is reported to illustrate this latter indication.

REPORT OF A CASE  A 47-year-old man presented with acute cholecystitis at another hospital. The diagnosis was confirmed with a positive biliary flow study and an ultrasound study showing multiple stones, with one impacted in the neck of the gallbladder. The common duct was of normal caliber, but the bilirubin level was slightly elevated at 22 μmol/L. All other liver enzyme levels were normal. Four weeks later, an elective laparoscopic cholecystectomy was performed. At surgery, hydrops of the gallbladder was found. The distal cystic duct was clipped, and four clips


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