Original article Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury F. A. Alvarez, M. de Santiba ˜ nes, M. Palavecino, R. S´ anchez Clari ´ a, O. Mazza, G. Arbues, E. de Santiba ˜ nes and J. Pekolj Hepato-Pancreato-Biliary Surgery Section and Liver Transplant Unit, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Per ´ on 4190, C1181ACH, Buenos Aires, Argentina Correspondence to: Dr J. Pekolj (e-mail: juan.pekolj@hospitalitaliano.org.ar) Background: The role of intraoperative cholangiography (IOC) in the diagnosis, prevention and management of bile duct injury (BDI) remains controversial. The aim of the present study was to determine the value of routine IOC in the diagnosis and management of BDI sustained during laparoscopic cholecystectomy (LC) at a high-volume centre. Methods: A retrospective analysis of a single-institution database was performed. Patients who underwent LC with routine IOC between October 1991 and May 2012 were included. Results: Among 11 423 consecutive LCs IOC was performed successfully in 95·7 per cent of patients. No patient had IOC-related complications. Twenty patients (0·17 per cent) sustained a BDI during LC, and the diagnosis was made during surgery in 18 patients. Most BDIs were type D according to the Strasberg classification. The sensitivity of IOC for the detection of BDI was 79 per cent; specificity was 100 per cent. All injuries diagnosed during surgery were repaired during the same surgical procedure. Two patients developed early biliary strictures that were treated by percutaneous dilatation and a Roux-en-Y hepaticojejunostomy with satisfactory long-term results. Conclusion: The routine use of IOC during LC in a high-volume teaching centre was associated with a low incidence of BDI, and facilitated detection and repair during the same surgical procedure with a good outcome. Paper accepted 31 January 2014 Published online 24 March 2014 in Wiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.9486 Introduction The incidence of bile duct injury (BDI) during laparoscopic cholecystectomy (LC) has not declined in the past few decades. BDI is a serious complication, often requiring assessment and treatment by experts 1,2 . Most patients referred to a tertiary centre have complex BDI, mainly as a result of late diagnosis or failed attempts at repair by inexperienced surgeons 3–5 . Intraoperative repair of BDI has recently been suggested as a useful therapeutic strategy. It is associated with low morbidity and the shortest path to achieve excellent long- term results 6 . However, immediate repair of BDI during LC is done infrequently because the diagnosis of BDI is often made after surgery 7,8 . The role of routine intraoperative cholangiography (IOC) during LC has been debated over the past 25 years 2,9 – 13 . It is still uncertain whether IOC prevents BDI or not. However, not much is known about the role of IOC in the diagnosis and subsequent treatment of BDI during the same surgical procedure. Some of the advantages of intraoperative diagnosis and definitive treatment of BDI include avoiding organic sequelae and the high treatment costs of late detection of cases, and reducing lawsuits 1,14 . A recent study 15 concluded that in a high-volume hepatobiliary centre it is possible to achieve an adequate scenario for the management of BDI: low incidence, less complex lesions, high rate of intraoperative diagnosis and repair by an experienced surgeon with excellent long-term results. The aim of this study was to determine the value of routine IOC in the diagnosis and management of BDI during LC at a high-volume centre. Methods A retrospective analysis of a single-institution LC database was carried out. All patients with a diagnosis of BDI sustained during LC at the Hospital Italiano de Buenos  2014 BJS Society Ltd BJS 2014; 101: 677–684 Published by John Wiley & Sons Ltd