Routine Vs Selective Intraoperative Cholangiography During Laparoscopic Cholecystectomy: A systematic Review with descriptive quantitative synthesis of Perioperative Outcomes-Recent Evidence.
Laparoscopic cholecystectomy (LC) is the standard surgical treatment for symptomatic gallstone disease; however, bile duct injury (BDI) remains a rare but serious complication associated with significant morbidity and healthcare cost. Intraoperative cholangiography (IOC) is frequently used to delineate biliary anatomy and detect common bile duct (CBD) stones, yet the role of routine versus selective IOC remains controversial. This systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with the International Prospective Register of Systematic Reviews (PROSPERO), evaluated contemporary evidence comparing routine and selective IOC during LC. PubMed, Scopus, Web of Science, and Google Scholar were searched for studies published between January 2013 and January 2025. Seventeen studies met inclusion criteria. Across included analyses, routine IOC was consistently associated with lower reported BDI rates, with most studies demonstrating rates of approximately 0.2%–0.4% compared with 0.6%–0.9% in selective strategies. Routine IOC also demonstrated improved detection of unsuspected CBD stones and earlier identification of intraoperative injury. This benefit was accompanied by a modest increase in operative duration, typically seven to ten minutes, and slightly higher procedural cost. Complication rates were comparable or modestly lower in routine IOC cohorts, and several large registry-based studies reported lower reoperation and readmission rates. Although the absolute reduction in BDI is small, the clinical and economic implications of preventing major biliary injury are substantial. The available evidence supports a liberal or routine use of IOC, particularly in patients with complex anatomy or elevated operative risk.
Keywords: Laparoscopic cholecystectomy, intraoperative cholangiography, bile duct injury, critical view of safety, gallstones, ICG fluorescence, surgical safety, systematic review.
