I do claims defense for a medmal insurer. I can certainly tell you that there is no shortage of respected surgeons (sometimes academic, sometimes commmunity) who are willing to testify for the plaintiff that always doing a cholangiogram is the standard of care. It can be difficult to successfully rebut that testimony. It is generally spun as thus: a simple test, taking only 15 minutes to do, and costing less than $ 150, would likely have prevented this outcome. If only the surgeon had done the test, the patient would not have become septic, needed emergency surgery to repair the damage, had five days postop in the ICU and lost two months of work, not to mention the pain and suffering. If the jury buys this, they can award some respectable verdicts against the surgeon.

I have used Dr. Way as a defense expert many times over the years and find his comments interesting. I wonder if always doing this study will become the defacto standard of care. Although there is a certain amount of CBD damage that can occur during the study.

The plaintiff attorneys will likely cite the WSJ and AJS articles as further evidence that intraop cholangiography is, or should be, the standard of care.

I’m sure most surgeons have their own indications for cholangiograms. Mine are as follows.

1. Can’t see shit. (Anatomy not clearly defined.)
2. Bump in LFTs indicative of possible CBD stone.
3. Something bad may have happened and it’s better to find out now than later.

It used to be recommended for routine cholangiography in training programs and perhaps that’s the perspective of Dr. Way. But cholangiogram certainly wasn’t routine in open cholecystectomy so I’m not sure why it should be routine in laparoscopic cholecystectomy.