Indocyanine Green (ICG) Fluorescence Cholangiography Versus Conventional Meth-ods in Preventing Bile Duct Injury During Difficult Laparoscopic Cholecystectomy: A Retrospective Study

Background: Bile duct injury (BDI) is one of the most serious complications of laparoscopic cholecystectomy, especially in difficult cases. Indocyanine Green (ICG) fluorescence cholangiography has emerged as a real-time intraoperative imaging modality that may improve biliary anatomy visualization and reduce the risk of injury. Objective: To compare the effectiveness of ICG fluorescence cholangiography with conventional identification methods in preventing bile duct injury during difficult laparoscopic cholecystectomy. Methods: This retrospective study was conducted at Lucknow Career Institute of Medical Sciences and Research from March 2022 to March 2025 and included 150 patients undergoing difficult laparoscopic cholecystectomy. Patients were divided into two groups: ICG fluorescence cholangiography group (n=75) and conventional technique group (n=75). Outcomes assessed included bile duct injury, operative time, conversion to open surgery, intraoperative complications, and length of hospital stay. Results: The incidence of bile duct injury was significantly lower in the ICG group (1.3%) compared to the conventional group (8.0%) (p=0.042). Mean operative time was shorter in the ICG group (78.4 ± 14.6 minutes) versus conventional group (92.7 ± 16.2 minutes) (p<0.001). Conversion to open surgery occurred in 5.3% of ICG cases versus 13.3% in conventional group (p=0.048). Postoperative hospital stay was significantly reduced in the ICG group (3.1 ± 1.2 days vs 4.6 ± 1.5 days; p<0.001). Conclusion: ICG fluorescence cholangiography significantly reduces bile duct injury, operative time, and conversion rates in difficult laparoscopic cholecystectomy. It is a valuable adjunct for improving surgical safety. Keywords: ICG fluorescence, bile duct injury, laparoscopic cholecystectomy, fluorescence cholangiography, difficult gallbladder