Vol. 1 No. 2 (2026): INTRAOPERATIVE CHOLANGIOGRAM IN ROUTINE CHOLECYSTECTOMY: REAL BENEFIT VERSUS OVERUSE OF AVAILABLE RESOURCES
Vol. 1, Issue No. 2 | July 2026
Intraoperative cholangiography (IOC) has long been used during cholecystectomy to improve visualization of the biliary anatomy and detect common bile duct stones. However, its routine use remains a subject of ongoing debate, particularly regarding its effectiveness in preventing bile duct injuries and its impact on operative time, healthcare costs, and resource utilization.
This review article in the Journal of the European Society of Surgery (JESS) critically examines the current evidence comparing routine and selective intraoperative cholangiography during laparoscopic cholecystectomy. The review evaluates the role of IOC in bile duct injury prevention, detection of choledocholithiasis, operative efficiency, and cost-effectiveness while assessing whether routine implementation offers meaningful clinical advantages over a selective, risk-based approach.
The findings suggest that although IOC improves the early recognition of biliary injuries and assists in identifying anatomical variations, its routine application does not significantly reduce the overall incidence of bile duct injury. Instead, a selective approach based on patient risk factors and intraoperative findings appears to provide a more balanced strategy, optimizing patient safety while reducing unnecessary procedures and healthcare expenditure. This review offers valuable guidance for general surgeons, hepatobiliary specialists, surgical trainees, and healthcare professionals involved in evidence-based gallbladder surgery.
