The Routine Use of Cholangiography for Laparoscopic Cholecystectomy in the Modern Era

Abstract

Background and Objectives:The use of routine versus selective intra-operative cholangiogram (IOC) for laparoscopic cholecystectomy (LC) remains an area of debate. In this study, we investigated the routine use of IOC in a single center, to determine whether it confers a reduced risk of common bile duct (CBD) injury and improved patient outcomes. We also identified several preoperative predictive factors for CBD stone detection on IOC to investigate the feasibility of a predictive model.Methods:We identified 1005 LCs with routine IOC over a 2-year period at the Norfolk and Norwich University Hospital from October 1, 2013, to September 30, 2015. Outcomes measured included CBD stone detection on IOC, CBD injury, complication rates, readmission rate, and mortality. We also calculated sensitivity, specificity, and likelihood ratios for detection of CBD stones on IOC from preoperative biochemistry and radiological investigations.Results:We identified a CBD stone detection rate of 10.1% and a readmission rate of 0.03%, with no reported CBD injuries and 1 reported mortality. Of the preoperative predictive factors investigated, the most specific for CBD stone detection on IOC was bilirubin at 89%. The most sensitive was preoperative MRCP at 77%.Discussion:This study demonstrates that routine IOC is an effective method of detecting CBD stones and CBD injuries, resulting in improved patient outcomes and economic benefits for health services. We have also identified several predictive factors for CBD stones on IOC.

Assessment of Laparoscopic Intraoperative Cholangiogram in Controlling Postoperative Outcomes and Its Implication on the Quality of Life

“…The most common complication was wound infection (N=2) followed by equal frequencies of intraabdominal collection, pancreatitis, bile leak, bleeding, and postoperative hernia (N=1). Similarly, Photi et al found that wound infection was the most common postoperative complication, followed by bleeding, sepsis, bile leak, and pancreatitis (23) . The higher frequency of wound infection in the latter study is explained by their larger sample size (1005), compared to ours (56).…”

A meta-analysis of the use of intraoperative cholangiography; time to revisit our approach to cholecystectomy?

“…A selective policy of IOC use was adopted in 14 studies with a mean IOC use of 16.7% (2.8%–36.9%) in 12,064 patients [ 18 , 19 , 34 , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] ]. Additionally, 14 studies adopted a policy of routine IOC with a mean average use of 88.3% (63.5%–99.2%) in 25,072 patients [ 17 , 19 , 34 , 37 , 42 , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] ].…”

Outcomes From Routine Use of Intraoperative Cholangiogram in Laparoscopic Cholecystectomy: Factors Predicting Benefit From Selective Cholangiography

“…Although the overall detection rate of CBD stones is low (5.8%), confirmed by subsequent ERCP, no patients in our cohort were readmitted with CBD stones. The reported incidence of CBD stones varied between 8-15% [8][9][10][11]. Furthermore, preoperative investigations are not predictive of negative IOC with some patients having filling defects on IOC despite nonsuggestive preoperative findings.…”