Predictive value and main determinants of abnormal features of intraoperative cholangiography during cholecystectomy

Azary, Shahram Yousefpour; Kalbasi, H.; Setayesh, Ali; Mousavi, Mirhadi; Hashemi, Asad; Khodadoostan, Mahsa; Zali, Mohammad Reza; Alizadeh, Amir Houshang Mohammad

doi:10.1016/s1499-3872(11)60051-9

Cited by 17 publications

(6 citation statements)

References 20 publications

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“…It is true that IOC leads surgeons to a better identification of the biliary tract, decreases the rates of biliary injuries and missed CBD stones [7,8,11,[30][31][32], and aids physicians in the early intraoperative detection of the injury [33]. This method, however, is burnened by morbidity and should only be performed in facilities where the necessary equipment and experience are available.…”

Section: Discussionmentioning

confidence: 99%

Bile Duct Injury during Laparoscopic Cholecystectomy without Intraoperative Cholangiography: A Retrospective Study on 1,100 Selected Patients

Pesce

Portale²,

Minutolo³

et al. 2012

Dig Surg

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Background: Whether to routinely or selectively use intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) has been a controversial issue for many years. Many authors maintain that IOC decreases the rate of biliary complications such as bile duct injuries, biliary leak, and missed common bile duct (CBD) stones. However, in contrast to these claims, many centers have opted to perform LC without IOC. In this retrospective study, the results of a series of 1,100 LCs, all of which involved major biliary complications and which were performed without the use of IOC, were reviewed. Methods: Data from 1,100 selected patients (728 females and 372 males) undergoing LC without the use of IOC from January 2003 to November 2011 were analyzed. One hundred and seventy LCs were performed by young surgeons during the learning curve, and 930 by surgeons with over 10 years of experience. Two techniques were used to create pneumoperitoneum: the Veress technique in 319 cases (29%) and the Hasson technique in the remaining 781 cases (71%). Patients with a suspicion of CBD stones were excluded from the study. Results: Two CBD injuries (0.18%) and three biliary leaks (0.27%) were detected among this group. Thirty-three patients (3%) needed conversion to open cholecystectomy. Missed CBD stones were reported in 4 cases (0.36%). There was no postoperative mortality. Conclusion: LC can be performed safely without the use of IOC and with acceptable low rates of biliary complications. An accurate preoperative evaluation of clinical risk factors, precise operative procedures, and conversion to an open approach in doubtful cases are important measures which must be taken to prevent CBD injury.

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Section: Discussionmentioning

confidence: 99%

Bile Duct Injury during Laparoscopic Cholecystectomy without Intraoperative Cholangiography: A Retrospective Study on 1,100 Selected Patients

Pesce

Portale²,

Minutolo³

et al. 2012

Dig Surg

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“…There are many options this group could have chosen for preoperative or intraoperative diagnosis of suspected common bile duct stones. The current role of IOC is a contentious one when pertaining to the prevention of common bile duct injures and the management of common bile duct stones [20]. Uncertainty regarding the benefit of IOC leads to wide variation in use across surgeons and hospitals [21, 22].…”

Section: Discussionmentioning

confidence: 99%

“…Surgeon preference and hospital accommodations seem to be the most important determinant of IOC utilization as opposed to patient disease characteristics [23]. In the current body of literature, unsuspected stones identified on IOC ranges from 0.9 to 10 %, with most authors reporting values of 3–7 % [20]. There also is the possibility of utilizing IOC followed by stone removal via the cystic duct or common bile duct in the same operative time.…”

Section: Discussionmentioning

confidence: 99%

ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure: a random comparison to the standard (two-step) procedure

et al. 2012

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Background Current treatment of complicated calculous biliary disease typically involves a two-step procedure consisting of preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Alternatively, laparoscopic cholecystectomy with intraoperative cholangiogram (IOC) and intraoperative common bile duct exploration or ERCP at a later date may be performed. This study compared the benefits of the traditional two-step procedure to the novel one-step procedure for the management of calculous biliary disease. Methods A retrospective review of 20 patients was conducted comparing one-step to two-step procedures for the management of choledocholithiasis. We define the one-step procedure to be a laparoscopic cholecystectomy with IOC to confirm the presence or absence of stones. Intraoperative ERCP with stone extraction was conducted if necessary as part of the one-step procedure. Results A statistically significant difference existed between hospital charges for one-step ($58,145.30, SD $17,963.09) and two-step ($78,895.53, SD $21,954.78) procedures (p = 0.033). Other parameters (length of stay, preoperative days) trended toward significance; however, statistical significance was not achieved. Conclusions There appears to be a significant cost reduction with implementation of the one-step treatment of calculous biliary disease. Further research with a larger study population is necessary to determine the additional benefits of this procedure and to help augment the surgical endoscopists’ armamentarium.

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“…LIOC is a safe and accurate method for the assessment of bile duct anatomy and stones [4]. Attention should be paid to the legal implications of documentation of the biliary anatomy.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Intraoperative Cholangiography Interpretation by Surgeons versus Radiologists, A Comparative Study and Review of 200 Cholangiographies

El‐Hennawy

El-Kahlout

Bedair

et al. 2012

ISRN Minimally Invasive Surgery

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Introduction. In some medical centers, LIOC are exclusively interpreted by surgeons. The degree of accuracy of surgeon's interpretation compared to that of radiologist (gold standard) and its clinical significance are not well studied. Objective. study whether surgeons are accurate in interpreting IOC or not by comparing the interpretation of LIOC by surgeons to the postoperative interpretation of same cholangiograms by radiologists, and study its clinical significance. Methods. A retrospective study of 200 consecutive patients who underwent selective LIOC in Al-Khor community hospital in Qatar during the period from May 2005 till December 2011. A radiology senior consultant blindly reviewed the cholangiograms (Reading B) then we compared these findings (ductal dilatation, defects of filling and passage of contrast into duodenum) to LIOC results that were reported intraoperatively by surgeons for the same patients (Reading A). Results. Ductal dilatation was found in (27.5%) of Reading A compared to 19% in Reading B. filling defects were reported in (20.5%) of Reading A compared to 14.5% in Reading B. Conclusion. there is significant difference of LIOC interpretation between surgeons and radiologist specially in the detection of defects of fillings although this variability did not affect the clinical outcome.

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Predictive value and main determinants of abnormal features of intraoperative cholangiography during cholecystectomy

Cited by 17 publications

References 20 publications

Bile Duct Injury during Laparoscopic Cholecystectomy without Intraoperative Cholangiography: A Retrospective Study on 1,100 Selected Patients

Bile Duct Injury during Laparoscopic Cholecystectomy without Intraoperative Cholangiography: A Retrospective Study on 1,100 Selected Patients

ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure: a random comparison to the standard (two-step) procedure

Laparoscopic Intraoperative Cholangiography Interpretation by Surgeons versus Radiologists, A Comparative Study and Review of 200 Cholangiographies

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