The authors present the results of 500 laparoscopic cholecystectomies (LC), employing intraoperative cholecystocholangiography and the ligature of the gallbladder pedicle with nylon suture instead of metallic clips. Most (79, 4%) patients were female and the median age was 48.2 years. Chronic cholecystitis was found in 424 patients, acute cholecystitis in 68, gallbladder cancer in four; acalculous cholecystitis in three and gallbladder polyp in a single patient. Stones in the CBD were diagnosed in twenty (4%) patients. The mean operating time was 84 minutes. Of the 500 patients, 93.4% were discharged from the hospital within 48 hours after LC. Convertion was required in 39 (7.8%) cases, mainly due to choledocholithisasis (15 patients) and acute cholecystitis (14 patients). Clinically important complications developed in 12 (2.4%) patients, including one (0,2%) commom bile duct injury. The mortality rate was 0.4%. Cholecystocholangiography was satisfactory in 80.5% and inconclusive in 19.5% of the patients. This method is an excellent option for intraoperative cholangiography in LC because it is technically very simple and affords good results, mainly in chronic cholecystitis. Nevertheless, when there is obvious cystic duct obstruction, or when the gallbladder is filled with biliary mud, it is better to do primarely transcystic cholangiography. Numerous studies have indicated that the use o metallic clips in LC is associated with higher risks of bile peritonitis and hemorrhage. Besides that, this study has shown that the use of clips make the procedure much more expensive, when the great number of LC performed yearly is considered. On the other hand, the cystic duct and artery ligation with nylon suture is very segure and cost saving.
Cholangiography; Cholecystectomy; Laparoscopic surgery; Cystic duct; Sutures