Cholangiography use endorsed in cholecystectomy

Bile duct injury significantly impairs survival after cholecystectomy, particularly when it goes undetected during surgery, show the results of a study published in the BMJ.

Furthermore, the authors found that even unsuccessful attempts to use intraoperative cholangiography resulted in better outcomes than when none were made at all.

"The significant advantage in survival among patients for whom intraoperative cholangiography was intended suggest that routine use during cholecystectomy might be beneficial," write Björn Törnqvist (Karolinska Institute, Stockholm, Sweden) and colleagues.

The study used data from 51,041 cholecystectomies recorded in the Swedish gallstone registry (GallRiks) between May 2005 and December 2010. Overall, there were 747 bile duct injuries of which 170 were detected during the primary cholecystectomy and 577 during the postoperative period.

The rate of death within a year was 3.9% in patients with a bile duct injury compared with 1.1% in patients without.

However, while patients whose injury was not detected until after the operation had a 95% increased risk for death over patients without injury, the risk for death was not significantly higher among patients whose injury was detected during surgery.

Törnqvist and colleagues believe this could be because delayed detection is frequently associated with bile leakage - a significantly negative prognostic factor that can result in chemical peritonitis and infection.

Interestingly, they also found that the intention to use intraoperative cholangiography significantly reduced the risk for death by 62% compared with patients in whom no cholangiography was attempted.

While several previous studies have shown an association between intraoperative cholangiography and improved survival, its use is still debated.

Törnqvist and colleagues believe theirs is the first study to include data on both performed cholangiography and intended but failed procedures. They explain that this is important, as operations where cholangiography is difficult may be more likely to result in bile duct injury.

They conclude that their study findings "strongly suggest that survival is impaired by failure to detect iatrogenic bile duct injury during cholecystectomy, and that use of intraoperative cholangiography significantly improved survival after cholecystectomy."

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