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Laparoscopic cholecystectomy (LC) is the preferred technique for the removal of symptomatic gallstones. Additional surgical approach is warranted if intraoperative choledocholithiasis (IOC) is detected by intraoperative cholangiography (IOC). Although the impact of IOC on the recurrence rate of gallstones after LC is controversial, many surgeons advocate the conversion of emergent LC (clamshell LC) to open cholecystectomy in patients with IOC. However, the risk of IOC during LC, the appropriate surgical approach for those patients, and the impact of IOC on the recurrence rate of gallstones after LC remains unclear. Of the 1,204 patients who underwent LC during a 22-month period at our institution, 72 patients with IOC (5.3%) were identified. These patients were retrospectively reviewed to evaluate the incidence of IOC, the therapeutic strategy, and the impact of IOC on the recurrence rate of gallstones after LC. IOC was associated with severe concomitant diseases in 40% of patients. Twenty-three patients with IOC were converted to open cholecystectomy. Among the 23 IOC patients, the operative period was relatively short (mean time, 4.1+/-3.2 days) and the duration of IOC (mean time, 2.6+/-2.1 days) was shorter than that of the patients without IOC. The incidence of IOC in the patients with preoperative cholangiography was 4.4% (5 of 117 patients), which was similar to the incidence of IOC in the patients without preoperative cholangiography (3.6% of 1,077 patients). In contrast, the incidence of IOC in the patients with preoperative ultrasonography was much lower (1.8% of 312 patients). Two patients with IOC (9.5%)
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