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

Written By : Dr.Niharika Harsha B |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2024-12-16T21:00:53+05:30  |  Updated On 17 Dec 2024 12:18 PM IST
Routine Cholangiography during cholecystectomy associated with reduced bile duct injuries: Study
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A recent ground-breaking study found that routine cholangiography reduced the odds of bile duct injuries and increased the chance of intraoperative recognition of major bile duct injuries in individuals while undergoing cholecystectomy as per results that were published in the journal JAMA Surgery.

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.

Also Read: T-Tube versus Choledochoscopy: Equally Effective for Post-Surgical Bile Duct Stone Detection, Study Finds

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.
Also Read:Intra-operative or CT cholangiography- which is better for biliary imaging in laparoscopic cholecystectomy?

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.

CholangiographyJAMA SurgeryAbby Grosscholecystectomy
Source : JAMA Surgery
Dr.Niharika Harsha B
Dr.Niharika Harsha B

    BDS, MDS

    Dr.Niharika Harsha B (BDS,MDS) completed her BDS from Govt Dental College, Hyderabad and MDS from Dr.NTR University of health sciences(Now Kaloji Rao University). She has 4 years of private dental practice and worked for 2 years as Consultant Oral Radiologist at a Dental Imaging Centre in Hyderabad. She worked as Research Assistant and scientific writer in the development of Oral Anti cancer screening device with her seniors. She has a deep intriguing wish in writing highly engaging, captivating and informative medical content for a wider audience. She can be contacted at editorial@medicaldialogues.in.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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