Also in cases of bile duct injuries during laparoscopic cholecystectomy operative cholangiogram
seems useful to provide an accurate "Road map" to define the pertinent anatomy and immediate detection of bile duct injuries when it occurs.
It is our policy to perform selective intra-operative cholangiograms
in patients with abnormal LFTs but no ultrasonographic evidence of choledocholithiasis pre-operatively, or if there are any concerns intra-operatively in identifying the biliary anatomy.
This has the advantage of not being severely limited by the level of serum bilirubin the way an intravenous cholangiogram
(which is available in many centers) is limited (3-5).
In a number of hospitals, GI radiographers routinely perform a broad range of studies, including barium swallows and meals, proctograms, T-tube cholangiograms
and small bowel examinations.
In a brilliant stroke, the surgeons left the catheter clipped in the cystic duct so that they could perform repeat cholangiograms
at 48 hours and 6 weeks.
Many surgeons perform cholangiograms
routinely, and some have described the procedure as creating a "safety zone.
Mini-cholecystectomy" and operative cholangiograms
, a means of cost containment.
Flum and his associates at the University of Washington, Seattle, found that intraoperative cholangiograms
(IOCs) had been performed in 613,706 (39%) of 1,570,361 patients nationwide who had a cholecystectomy in 1992-1999.