INTRAOPERATIVE CHOLANGIOGRAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY: WHAT ROLE? GIOVANNI TOMASELLO 1 , VINCENZO DAVIDE P ALUMBO 1 , PROVVIDENZA DAMIANI 2 , FRANCESCO DAMIANI 3 , GIUSEPPE DAMIANO 1 , GABRIELE SPINELLI 1 , FILIPPO MAURIZIO ACCARDO 4 , A TTILIO IGNAZIO LO MONTE 1 1 Dpt of Surgical and Oncological Disciplines, University of Palermo, 2 Dpt of Internal and Specialistic Medicine, 3 Dpt of Emergency, Urgency and Neurosciences, University of Palermo, Italy, 4 Dpt of Statical and Mathematical Sciences “S. Vianelli” University of Palermo [Colangiografia intraoperatoria in corso di colecistectomia laparoscopica: quale ruolo?] Introduction The routinary use of intra-operative cholan- giography (IOC) during cholecystectomy is still controversial, even today, in laparoscopic era. In 1931, Mirizzi first recommended its use during open cholecystectomy, because of the high inci- dence of missed choledocolithiasis after the opera- tion.1 Use of IOC during open surgery, has drasti- cally reduced the rate of unnecessary intra-opera- tive choledocotomies. With the diffusion of laparo- scopic surgery, the incidence of iatrogenic lesions of the biliary tree has been increasing of about (3-4) times in comparison with open surgery (2-6) . In this last case, the lesions are usually caused by a wrong identification of the anatomical struc- tures, due to a variation in the anatomy of the bil- iary tree or an altered perivisceral anatomy follow- ing gallbladder inflammation. In this work we evaluate the role of IOC in prevention of biliary tree iatrogenic lesions and early identification of choledocolithiasis, during laparoscopic cholecystectomy. Materials and methods From December 2008 to January 2010, 184 patients, 73 male and 111 female, underwent a laparoscopic cholecystectomy. Age ranged from 19 to 78 years. Prior to operation, all patients were evaluated for serum hepatic enzymes and studied by abdominal ecotomography (ETG). Fifteen patients (6 male and 9 female) with choledocolithi- asis, underwent Endoscopic Retrograde Acta Medica Mediterranea, 2012, 28: 281 ABSTRACT Aim: Laparoscopic cholecystectomy has increased the number of iatrogenic lesion of the biliary tree. In this study, we evaluate the role of intra-operative cholangiography in prevention of biliary tree iatrogenic lesions and early identification of choledocolithia- sis, during laparoscopic cholecystectomy. Material of study: 169 patients who underwent laparoscopic cholecystectomy, were evaluated by means of intra-operative cholangiography. Patients were divided into two groups basing on the risk to develop biliary tree lithiasis. Discussion: Patients with a higher risk of postoperative complications effectively showed cholangiographic anomalies, includ- ing duct stones, dilations, anatomical variations, and iatrogenic lesions of the biliary tree. Intra-operative cholangioraphy avoided iatrogenic lesions, allowing the surgeon to recognize the anatomical structures of the biliary tree, even for unusual cases. Conclusions: Intra-operative cholangiography has still a role in preventing all above mentioned complications related to biliary tree laparoscopy, depicting perfectly the anatomy of the biliary tree and diagnosing common bile duct lithiasis during intervention, especially in selected cases with a higher risk to develop complications. Key words: Cholelithiasis, choledocolithiasis, biliary tree iatrogenic lesions, post-cholecystectomy complication.s Received September 14, 2012; Accepted October 12, 2012