Intraoperative cholangiography using a balloon catheter in liver surgery

To prevent intraoperative injury of the bile ducts, we designed a balloon catheter and used it in the intraoperative cholangiography of 36 patients undergoing hepatectomy for primary carcinoma of the liver at the Second Department of Surgery of Osaka City University Hospital during the past 4 years. After cholecystectomy, the balloon catheter was inserted through the cystic duct up to the common bile duct, and cholangiography was performed before and after liver resection. This method makes intrahepatic bile ducts easier to visualize. In 14 of the 53 patients in whom cholangiography using a balloon catheter or conventional catheter was done, the abnormal branching of the intrahepatic bile ducts was found before resection, and the liver was resected without injuring the ducts. In 2 of the 36 patients in whom cholangiography with a balloon catheter was performed, leakage of the contrast medium from the resected liver surface was visible, and this part of the liver was sutured. With this new method, postoperative complications caused by bile leakage decreased. No side effects developed after the balloon catheter was used. We have used basically the same technique in other kinds of hepatobiliary disease.