Intraoperative cholangiogram

Intraoperative cholangiogram refers to the radiographic contrast based examination of the bile duct during surgery.

Helps deliniate the anatomy of the biliary tree.

Detects the presence of biliary stones in the common bile duct.

Used to avoid injury to the biliary system during laparoscopic cholescystectomy.

When the cystic duct/gallbadder junction exposure is inadequate, or traction on the cystic duct/common bile duct junction exists, the common bile duct can be mistaken for the cystic duct and be injured inadvertently.

Presently intraoperative cholangiogram is used selectively to prevent common bile duct injury or to evaluate the presence of stones in the common bile duct.

During the procedure the cystic duct is identified at the junction of the gallbladder neck and a ductomy is performed with placement of a cholagio catheter, which is fixed in place: radiographic contrast is then infused and fluoroscopic images obtained.

Identification of the cystic duct or biliary stones allows for appropriate division of biliary structures.

Analyses of studies suggest routine use of IOC halves the rate of common bile injury.

Adds16 minutes to laparoscopic cholecystectomy.

Common bile duct injuries relative infrequent during cholecystectomy:1:200-1:400.

Repair of common bile duct injuries is complex and may require muliple surgical procedures.

Nearly a 3 fold increased risk of death among individuals that experience common bile duct injuries compared to those without such injury.

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