الفهرس 
Intra hepatic biliary anatomyOnly 14 pages are availabe for public view
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Abstract
Our study is conducted on 23 patients with age range 21-59 years (8 males & 25 females) who were presented by chronic cholecystitis to gastrointestinal and laparoscopy unit from March 2017 to October 2018. The aim of this study was to evaluate the protective effect of selective use of intraoperative cholangiography during laparoscopic cholecystectomy in patients with high risk for bile duct injuries predicted by preoperative and intraoperative factors.. Recurrent attacks of right hypochondrial pain was the main presenting symptom in all patients, 13 patients (56.5%) presented by right hypochondrial tenderness, 10 patients (43.5%) had positive Murphy’s sign. 11 patients had history of obstructive jaundice. 13 cases (56.5%) presented by positive CRP, while TLC was elevated in 6 cases (26.1%). SGOT was elevated in 11 patients (47.8%), SGPT was elevated in 9 cases (39.1%). 4 cases (17.4%) presented by elevated total bilirubin level and 6 cases (26.1%) presented by elevated direct bilirubin level. Ultrasound showed thickened gallbladder wall in 16 cases (69.6%), one case (4.3%) was acalcular, ultrasound showed edema in 11 cases (47.8%), mucocele in 5 cases (21.7%), pyocele in 4 (17.4%) and pericholecystic fluid in 7 cases(30.4%). CBD was dilated in 15 cases (65.2%). Total operative time was ranging from 40-240 minutes with mean ±SD 105.1 ±61.13. Blood loss ranged from 50-300 cc with mean± SD 128.26 ±67.13. Longer operative time was noted in cases presented preoperatively with positive CRP with significant difference 0.013, also operative time was long in cases in which ultrasound showed pericholecystic fluid, mucocele and pyocele with significant difference 0.037, 0.008, 0.025 respectively. In our study, we performed cystic duct cholangiography, cholecystocholangiography was not attempted in any case. Cannulation of cystic duct was successful in all cases (100%). IOC time was ranging from 10-40 minutes with mean± SD 22.74± 8.87 It was found that cases with longer operative time showed also long IOC time. This was clear in cases presented preoperatively with positive CRP, presence of right hypochondrial tenderness and positive Murphy’s sign with significant difference as follow 0.019, 0.019, 0.015 respectively. Also, longer IOC time with cases in which ultrasound findings noted presence of pericholecystic fluid , edema, mucocele and pyocele with significant difference 0.029, 0.032,0.009,0.048 respectively. Normal IOC was found in 20 cases (78%), in one case IOC showed low insertion of cystic duct. No cases of bile duct injury was identified intraoperative or presented postoperative, Abnormal IOC findings was found in 3 cases (13%). One case showed dilated CBD with distal stricture, intraoperative ERCP, and sphinctrotomy was done with good drainage. Two cases showed filling defects, one of them need intraoperative ERCP and the other underwent laparoscopic CBD exploration. Out of 11 cases with history of obstructive jaundice, 9 cases showed negative IOC and 2 cases showed positive IOC (filling defects). However, we reported a case with positive IOC (dilated CBD with distal obstruction) out of 12 cases with no history of obstructive jaundice.