Dataset Information

Feasibility, benefit and risk of systematic intraoperative cholangiogram in patients undergoing emergency cholecystectomy.

ABSTRACT:

Background

The role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the present study was to evaluate the feasibility, benefit and risk of performing systematic IOC in patients undergoing cholecystectomy for acute gallstone-related disease.

Methods

Between July 2013 and January 2015, all patients admitted for an acute gallstone-related condition and undergoing same-hospital-stay cholecystectomy were prospectively followed. IOC was systematically attempted and predictors of IOC failure were analyzed.

Results

Among the 581 enrolled patients, IOC was deliberately not performed in 3 cases. IOC was successful in 509/578 patients (88.1%). The main predictors of IOC failure were age, body mass index, male gender and associated acute cholecystitis. Thirty-two patients with suspected common bile duct stone on IOC underwent 38 unnecessary negative postoperative common bile duct investigations (32/509, 6.3%). There was one IOC-related adverse outcome (mild pancreatitis, 1/578, 0.2%).

Conclusions

IOC can be successfully and safely performed in the majority of patients undergoing cholecystectomy for acute gallstone-related disease. Although its positive predictive value is suboptimal and results in a number of unnecessary postoperative common bile duct investigations, IOC accurately rules out common bile duct stones in patients with acute gallstone-related conditions.

SUBMITTER: Iranmanesh P

PROVIDER: S-EPMC6023227 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Feasibility, benefit and risk of systematic intraoperative cholangiogram in patients undergoing emergency cholecystectomy.

Iranmanesh Pouya P Tobler Olivier O De Sousa Sandra S Andres Axel A Frossard Jean-Louis JL Morel Philippe P Toso Christian C

PloS one 20180628 6

<h4>Background</h4>The role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the present study was to evaluate the feasibility, benefit and risk of performing systematic IOC in patients undergoing cholecystectomy for acute gallstone-related disease.<h4>Methods</h4>Between July 2013 and January 2015, all patients admitted for an acute gallstone-related condition and undergoing same-hospital-stay cholecystectomy were prospectively followed. IOC was systematically ...[more]

PMID: 29953458

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Project description:Significant controversy exists regarding routine intraoperative cholangiography in preventing common duct injury during cholecystectomy.To investigate the association between intraoperative cholangiography use during cholecystectomy and common duct injury.Retrospective cohort study of all Texas Medicare claims data from 2000 through 2009. We identified Medicare beneficiaries 66 years or older who underwent inpatient or outpatient cholecystectomy for biliary colic or biliary dyskinesia, acute cholecystitis, or chronic cholecystitis. We compared results from multilevel logistic regression models to the instrumental variable analyses.Intraoperative cholangiography use during cholecystectomy was determined at the level of the patients (yes/no), hospitals (percentage intraoperative cholangiography use for all cholecystectomies at the hospital), and surgeons (percentage use for all cholecystectomies performed by the surgeon). Percentage of use at the hospital and percentage of use by surgeon were the instrumental variables.Patients with claims for common duct repair operations within 1 year of cholecystectomy were considered as having major common duct injury.Of 92,932 patients undergoing cholecystectomy, 37,533 (40.4%) underwent concurrent intraoperative cholangiography and 280 (0.30%) had a common duct injury. The common duct injury rate was 0.21% among patients with intraoperative cholangiography and 0.36% among patients without it. In a logistic regression model controlling for patient, surgeon, and hospital characteristics, the odds of common duct injury for cholecystectomies performed without intraoperative cholangiography were increased compared with those performed with it (OR,?1.79 [95% CI, 1.35-2.36]; P?<?.001). When confounding was controlled with instrumental variable analysis, the association between cholecystectomy performed without intraoperative cholangiography and duct injury was no longer significant (OR,?1.26 [95% CI, 0.81-1.96]; P?=?.31).When confounders were controlled with instrumental variable analysis, there was no statistically significant association between intraoperative cholangiography and common duct injury. Intraoperative cholangiography is not effective as a preventive strategy against common duct injury during cholecystectomy.

Dataset Information

Feasibility, benefit and risk of systematic intraoperative cholangiogram in patients undergoing emergency cholecystectomy.

Background

Methods

Results

Conclusions

Publications

Feasibility, benefit and risk of systematic intraoperative cholangiogram in patients undergoing emergency cholecystectomy.

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