Routine Cholangiography during cholecystectomy associated with reduced bile duct injuries: Study

Cholecystectomy is one of the most common surgeries performed globally. Intraoperative cholangiography (IOC) is an integral component of cholecystectomy and is performed either routinely or selectively. Routine cholangiography (RC) is advocated to avoid systemic bile duct injuries (BDI) during cholecystectomy and increase the quality of life. However, it is associated with increased costs due to invasive testing and increased postoperative imaging. Selective cholangiography (SC) is done in certain cases, citing long operative times and costs as one of the factors. As there is an ambiguity regarding the use of selective or routine cholangiography, researchers conducted a comparative study to understand the perioperative outcomes of cholecystectomy between surgeons who routinely vs selectively perform IOC.

A retrospective cohort study was carried out from January 2015 through June 2023 within the Cleveland Clinic Enterprise. About 18 hospitals and nine ambulatory surgery centers in 2 states Ohio and Florida, were included. The study included adult patients who underwent cholecystectomy for benign biliary disease. Routine cholangiography is defined as more than 70% of cholecystectomies performed with IOC per surgeon over the study period.

Findings:

• A total of 134 surgeons performed 28,212 cholecystectomies with 10,244 in the RC cohort.
• The mean age of participants in the RC cohort was 52.71 years.
• About 17,968 participants were included in the SC cohort.
• The mean age of the participants was 52.33 years.
• There were about 26 major BDIs (0.09%) and 105 minor BDIs (0.34%).
• RC was associated with decreased odds of major BDI and minor BDI compared with SC patients and surgeon characteristics were controlled.
• The intraoperatively RC cohort was associated with more recognition of major BDIs than the SC cohort.
• RC was not significantly associated with increased perioperative endoscopic retrograde cholangiopancreatography utilization or negative ERCP rate.

Thus, the study concluded that routine cholangiography significantly reduced major and minor bile duct injuries when compared to selective cholangiography. This underscores the importance of incorporating routine cholangiography as a health system strategy to reduce the risk of bile duct injuries in cholecystectomy.

Further reading: Gross A, Said SA, Wehrle CJ, et al. Selective vs Routine Cholangiography Across a Health Care Enterprise. JAMA Surg. Published online December 11, 2024. doi:10.1001/jamasurg.2024.5216.