Intraoperative Cholangiogram

What is an intraoperative cholangiogram?

An intraoperative cholangiogram is a type of imaging procedure your healthcare provider might perform during a gallbladder removal (cholecystectomy). It allows them to see the structure of your bile ducts (tubes that drain bile from your gallbladder and liver into your small intestine), how they connect and if there are any stones or other blockages in them. This helps the surgeon safely remove your gallbladder with less risk of damaging your bile ducts.

Another type of bile duct imaging, percutaneous transhepatic cholangiogram, is a separate procedure that providers use to diagnose and treat bile duct blockages.

What’s the purpose of an intraoperative cholangiogram?

Cholangiography during gallbladder surgery helps your provider:

• Identify small gallbladder stones (cholelithiasis) that aren’t causing symptoms.
• Detect bile duct damage.
• View the anatomy of your bile ducts. Differences in how the tube that drains bile from your gallbladder (cystic duct) and the tube that drains bile from your liver (common bile duct) connect can determine how your surgeon removes your gallbladder.

Why do I need an intraoperative cholangiogram?

Your provider decides when it makes sense to use intraoperative cholangiography. Some providers always use it (routine cholangiography), but others only use it under certain circumstances (selective cholangiography). They might choose to perform a cholangiogram if you:

• Have abnormal liver function test results.
• Have elevated pancreatic enzymes.
• Have or have recently had pancreatitis.
• Have jaundice.
• Have recently had an obstruction in your bile ducts, like gallstones.
• Had an ERCP (endoscopic retrograde cholangiopancreatography) but your provider wasn’t able to view your bile ducts or remove a blockage.

How does an intraoperative cholangiogram work?

Your healthcare provider performs an intraoperative cholangiogram during gallbladder surgery, after you’re under anesthesia. They insert a flexible tube through an incision (surgical cut) in your skin and inject contrast dye through it, into your bile ducts. Your provider then uses an X-ray machine to send images of your bile duct to a monitor. Contrast dye is a liquid that either blocks or absorbs more X-rays than the tissue around it, which makes structures in your body defined and more easily seen on medical imaging (it’s not the kind of dye that stains your skin).

How do I prepare for an intraoperative cholangiogram?

You prepare for an intraoperative cholangiogram the same way you’d prepare for gallbladder surgery without a cholangiogram.

Before a cholangiogram, you may need to:

• Not eat or drink anything (fast) for a certain amount of time before the procedure.
• Not take certain medications or alter your medication schedule. Don’t stop taking medications unless your provider tells you to.
• Arrange for someone to drive you home after the procedure.
• Tell your healthcare provider about any medications you take, including supplements.

What happens before an intraoperative cholangiogram?

Before a cholangiogram, your surgery team will prepare the same way they would for gallbladder surgery:

1. A provider will help you get into the correct position on the operating table.
2. An anesthesiologist will give you general anesthesia through an IV in your arm.
3. Your surgeon will make one or more incisions in your abdomen.

What happens during an intraoperative cholangiogram?

During an intraoperative cholangiogram, your surgeon:

1. Inserts a catheter through an incision in your skin into your cystic duct.
2. Injects contrast dye into the catheter.
3. Uses X-rays to see how the dye moves through your bile duct. They can view this on a monitor while performing surgery.
4. Removes any stones from your bile ducts during surgery, if they can.
5. Removes your gallbladder, using the monitor as a guide to prevent damage to your bile ducts.
6. Completes the cholecystectomy (gallbladder removal) and closes incisions.

What happens after an intraoperative cholangiogram?

After the cholangiogram, your provider will complete your gallbladder surgery. You’ll recover in the hospital. You might go home the same day or within a day or two.

What are the advantages of intraoperative cholangiogram?

An intraoperative cholangiogram as part of gallbladder surgery can:

• Reduce the risk of damage to your bile ducts during surgery by making them easy to see.
• Identify damage to your bile ducts.
• Identify small stones — that you and your provider might not have known were there — before they can cause issues.

What are the risks of intraoperative cholangiogram?

Risks of an intraoperative cholangiogram include:

• Allergic reactions to the contrast dye.
• Damage to your bile ducts.
• Infection.
• Bleeding.
• Pancreatitis.

When should I call my healthcare provider?

Contact your provider if you have any questions before or after the procedure, or if you experience:

• Unexpected or severe pain.
• Warmth, redness, swelling, bleeding or pus at the incision site.
• Fever.

A note from Cleveland Clinic

An intraoperative cholangiogram is a tool surgeons can use to lower the risk of complications during gallbladder surgery. It gives them a picture of your bile ducts that helps them plan the best way to perform the procedure based on your body. It can also help them identify stones and tissue damage before they can cause issues. Don’t hesitate to ask your provider about any concerns you have about the procedure.