To determine the safety of laparoscopic cholecystectomy without On-table cholangiography.

Quasi-experimental study.

Surgical “D” ward Khyber teaching hospital Peshawar from January 2005 to December 2008.

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.

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 postoperative leakage was found to be due to severed cholecystohepatic duct.

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.