N-OTC is associated with shorter operative time and fewer peri-operative complications , and it is comparable to R-OTC in terms of CBD injury risk during cholecystectomy .
R-OTC is helpful for peri-operative CBD stone detection and there is therefore reduced readmission for retained CBD stones .
The N-OTC approach may be adopted routinely for patients undergoing laparoscopic cholecystectomy providing there are no clinical , biochemical or radiological features suggestive of CBD stones .
INTRODUCTION The aim of this review was to systemically analyse trials evaluating the efficacy of routine on-table cholangiography ( R-OTC ) versus no on-table cholangiography ( N-OTC ) in patients undergoing cholecystectomy .
Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones.
INTRODUCTION Common bile duct ( CBD ) stones can cause serious morbidity or mortality , and evidence for them should be sought in all patients with symptomatic gallstones undergoing cholecystectomy .  Routine intra-operative cholangiography ( IOC ) involves a large commitment of time and re sources , so a policy of selective cholangiography was adopted . This study prospect ively evaluated the policy of selective cholangiography for patients suspected of having choledocholithiasis , and aim ed to identify the factors most likely to predict the presence of CBD stones positively . PATIENTS AND METHODS Data from 501 consecutive patients undergoing laparoscopic cholecystectomy ( LC ) for symptomatic gallstones , of whom 166 underwent IOC for suspected CBD stones , were prospect ively collected . Suspicion of choledocholithiasis was based upon : ( i ) deranged liver function tests ( past or present ) ; ( ii ) history of jaundice ( past or present ) or acute pancreatitis ; ( iii ) a dilated CBD or demonstration of CBD stones on imaging ; or ( iv ) a combination of these factors . Patient demographics , intra-operative findings , complications and clinical outcomes were recorded . RESULTS Sixty-four cholangiograms were positive ( 39 % ) . All indications for cholangiogram yielded positive results . Current jaundice yielded the highest positive predictive value ( PPV ; 86 % ) . A dilated CBD on pre-operative imaging gave a PPV of 45 % for CBD calculi ; a history of pancreatitis produced a 26 % PPV for CBD calculi . Patients with the presence of several factors suggestive of CBD stones yielded higher numbers of positive cholangiograms . Of the 64 patients having a laparoscopic common bile duct exploration ( LCBDE ) , four ( 6 % ) required endoscopic retro grade cholangiopancreatography ( ERCP ) for retained stones ( 94 % successful surgical clearance of the common bile duct ) and one ( 2 % ) for a bile leak . Of the 335 patients undergoing LC alone , three ( 0.9 % ) re-presented with a retained stone , requiring intervention . There were 12 ( 7 % ) requiring conversion to open operation . CONCLUSIONS A selective policy for intra-operative cholangiography yields acceptably high positive results . Pre-operatively , asymptomatic bile duct stones rarely present following LC ; thus , routine imaging of the biliary tree for occult calculi can safely be avoided . Therefore , a rationing approach to the use of intra-operative imaging based on the pre-operative indicators presented in this paper , successfully identifies those patients with bile duct stones requiring exploration . Laparoscopic bile duct exploration , performed by an experienced laparoscopic surgeon , is a safe and effective method of clearing the bile duct of calculi  , with minimal complications , avoiding the necessity for an additional intervention and prolonged hospital stay
N-OTC is associated with shorter operative time and fewer peri-operative complications , and it is comparable to R-OTC in terms of CBD injury risk during cholecystectomy .
R-OTC is helpful for peri-operative CBD stone detection and there is therefore reduced readmission for retained CBD stones .
The N-OTC approach may be adopted routinely for patients undergoing laparoscopic cholecystectomy providing there are no clinical , biochemical or radiological features suggestive of CBD stones .
INTRODUCTION The aim of this review was to systemically analyse trials evaluating the efficacy of routine on-table cholangiography ( R-OTC ) versus no on-table cholangiography ( N-OTC ) in patients undergoing cholecystectomy .