LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT INTRAOPERATIVE CHOLANGIOGRAPHY: AUDIT OF LONG TERM RESULTS Digestive and Laparoscopic Surgery, Maggiore Hospital, Bologna, Italy Running title: Laparoscopic cholecystectomy without intraoperative cholangiography

There is no uniform consensus on the utility of routine intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC). We present herein a ten-year retrospective audit of our cases of LC without IOC, performed by search of readmission cases through our electronic data base. Data regarding all patients subjected to LC at our Unit in the period January 1996 – December 2006 were obtained through our hospital data base system. Subsequently a query was made to ascertain if there were any readmissions to any of our city hospitals, up to December 2006. A total of 1321 patients underwent LC at our unit in the period 01/01/1996-31/12/2006. The median operating time for LC without IOC was 58 minutes (range 15 – 370 minutes). The median hospital stay was 2 days (range 1-30 days). Postoperative outcome was uneventful in 1250 patients (94.7%). There was no mortality. Grade I and II complications occurred in the remaining 71 patients. Patients were stratified by risk of common bile duct stones (BDS) according to clinical, ultrasonographic and serum chemistry data. Patients with suspected BDS underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) and BDS clearance (142 patients). No patient in our series of LC was readmitted to any of the city hospitals for biliary desease up to ten years after the operation. Our retrospective audit confirms the safety of LC without routine IOC and the rarity of readmissions for retained BDS, and supports the policy of selective IOC. Introduction There is no uniform consensus on the utility of routine intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC). Most laparoscopic surgeons advocate selective use of IOC (1), while others insist on the need of routine IOC (2). The main reason to perform IOC would be one-time detection and treatment of asymptomatic bile duct stones (BDS). However,