What Is an Intraoperative Cholangiogram?

An intraoperative cholangiogram is imaging of the bile ducts during a surgical procedure. This helps the surgeon get oriented in the body and can reduce the risk of injury to the bile ducts. Such injuries can require one or more surgeries to repair and can have a negative impact on patient health. Studies on the use of intraoperative cholangiography suggest it can be a cost-effective measure for protecting patient safety.

Surgeons may request an intraoperative cholangiogram in any procedure when they will be working with or around the bile ducts, particularly in a cholecystectomy, where the practitioner removes the gallbladder. These procedures are often performed endoscopically, with the use of tools inserted through small incisions and guided by a camera. It can be easy to get disoriented inside the body during such surgeries, and a surgeon may confuse structures near the gallbladder or accidentally injure the bile duct with pressure or clipping.


In the intraoperative cholangiogram, a technician injects a contrast medium that will highlight the bile ducts on an x-ray. Once the medium has a chance to circulate, a series of images can be taken to watch it move through the bile ducts. The resulting images highlight the anatomical structures in the area and provide important information for the surgeon about the location of the common bile duct. If there is a problem as a result of surgery, the surgeon can look for indications of potential trouble, which might include leaking contrast medium or an area of obstruction.

When a surgeon recommends a gallbladder removal or other surgery in this area, this may include a request for an intraoperative cholangiogram. Information about the test can be provided to the patient along with other material about the surgery. Surgeons typically strongly recommend imaging because it makes the surgery safer for the patient. General surgeons and others who perform gallbladder removal also have concerns about malpractice accusations, and thus take reasonable precautions to reduce the risk of complications and identify surgical errors as quickly as possible.

This test does carry some risks, as some patients are allergic to contrast media. People should discuss their allergies before the surgery so the doctor can determine if the intraoperative cholangiogram is likely to be safe. The risks of not checking on the bile ducts during surgery could be the primary concern. Patients who do not receive such imaging might need to go under anesthesia again for a corrective surgery to address an issue caused during the initial procedure, and this can increase the chance of infection and other complications.


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