Intraoperative cholangiography (IOC) may decrease the risk of common bile duct (CBD) injury during cholecystectomy. It may help to avoid misidentification of the CBD.
In this study, researchers from the United States investigated the relationship of IOC use and CBD injury, while controlling for patient and surgeon characteristics.
|Injury risk increased when intraoperative cholangiography was not used.|
|Journal of the American Medical Association|
The research team performed a retrospective nationwide cohort analysis of Medicare patients undergoing cholecystectomy, between 1992 and 1999.
The team defined common bile duct injury where a second surgical procedure to repair the CBD was required within 1 year of cholecystectomy.
The team also obtained surgeon demographic features from matching the Medicare Part B data to the American Medical Association Physician Masterfile database.
They assessed the frequency of CBD injury in patients who did and did not have IOC performed during cholecystectomy. The team controlled for patient age, sex, race, and case complexity. They also controlled for the surgeon’s age, sex, race, the year of surgical procedure, case order, percentage of IOC use in prior surgical procedures, years in medical practice, board certification, and specialization.
The database search identified 1,570,361 cholecystectomies and 7911 CBD injuries (0.5%).
The team identified common bile duct injury in 2380 of 613,706 patients undergoing cholecystectomy with IOC. This compared with 5531 of 956,655 patients undergoing cholecystectomy without IOC (unadjusted relative risk, 1.49).
After controlling for patient-level factors and surgeon-level factors, the risk of injury was increased when IOC was not used (adjusted relative risk, 1.71).
In addition, while surgeons performing IOCs routinely had a lower rate of CBD injuries than those who did not, this difference disappeared when IOC was not used.
Dr David Flum’s team concluded, “In this study of Medicare patients undergoing cholecystectomy in the 1990s, the risk of CBD injury was significantly higher when IOC was not used”.
“Although IOCs may not prevent all CBD injuries, this study suggests that the routine use of IOC may decrease the rate of CBD injury.”