Selective intraoperative cholangiography and risk of bile duct injury during cholecystectomy

• Published in: British journal of surgery Vol. 102; no. 8; pp. 952 - 958
• Main Authors: Törnqvist, B., Strömberg, C., Akre, O., Enochsson, L., Nilsson, M.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-07-2015; Oxford University Press
• Subjects: Acute Disease; Adult; Aged; Bile Ducts - injuries; Cholangiography; Cholecystectomy - adverse effects; Cholecystitis - surgery; Female; Humans; Iatrogenic Disease; Male; Medicin och hälsovetenskap; Middle Aged; Preoperative Period; Risk Factors
• ISSN: 0007-1323; 1365-2168; 1365-2168
• DOI: 10.1002/bjs.9832

Background
Whether intraoperative cholangiography can prevent iatrogenic bile duct injury during cholecystectomy remains controversial.
Methods
Data from the national Swedish Registry for Gallstone Surgery, GallRiks (May 2005 to December 2010), were analysed for evidence of iatrogenic bile duct injury during cholecystectomy. Patient‐ and procedure‐related risk factors for bile duct injury with a focus on the rate of intended intraoperative cholangiography were analysed using multivariable logistic regression.
Results
A total of 51 041 cholecystectomies and 747 bile duct injuries (1·5 per cent) were identified; 9008 patients (17·6 per cent) were diagnosed with acute cholecystitis. No preventive effect of intraoperative cholangiography was seen in uncomplicated gallstone disease (odds ratio (OR) 0·97, 95 per cent c.i. 0·74 to 1·25). Operating in the presence (OR 1·23, 1·03 to 1·47) or a history (OR 1·34, 1·10 to 1·64) of acute cholecystitis, and open surgery (OR 1·56, 1·26 to 1·94), were identified as significant risk factors for bile duct injury. The intention to perform intraoperative cholangiography was associated with a reduced risk of bile duct injury in patients with concurrent (OR 0·44, 0·30 to 0·63) or a history of (OR 0·59, 0·35 to 1·00) acute cholecystitis.
Conclusion
Any proposed protective effect of intraoperative cholangiography was restricted to patients with (or a history of) acute cholecystitis.
Only protective in acute cholecystitis