Contribution of intraoperative cholangiography to incidence and outcome of common bile duct injuries during laparoscopic cholecystectomy.
BACKGROUND
In the present study we examined, in a meta-analysis of the literature, the contribution of intraoperative cholangiography (IOC) to incidence, type, and time of diagnosis of common bile duct (CBD) injuries during laparoscopic cholecystectomy (LC).


METHODS
Forty of 2104 reports were enrolled for analysis. In 26 reports we found exact information on type, location and repair of 405 major injuries and in a subgroup examination we selected 103 major injuries with detailed information as to the event and size of CBD injury in association with IOC.


RESULTS
The main incidence of CBD injuries was 0.36%. Using the method of routine IOC the incidence was 0.21% and the rate of diagnosis at the time of cholecystectomy 87% in contrast to selective use of IOC with 0.43% and 44.5%. In 405 cases of major CBD injuries, severe injuries predominated in 83.9% of the cases. Reconstruction with the help of a bilio-digestive anastomosis was necessary in 45.7% of all patients. In 34.8% of the cases a second intervention had to be made in the follow-up of 4 years after LC. The analysis of type, severity, recognition, and follow-up of CBD injuries during LC w/wo IOC showed significant advantages for doing routine IOC.


CONCLUSIONS
The use of IOC can avoid severe types of CBD injuries during LC, increase the recognition at the time operation, and influence the success of repair and outcome of the patients.
Ludwig
K
K
Department of Surgery, Klinikum Suedstadt Rostock, Suedring 81, D-18059 Rostock, Germany. kaja.ludwig@kliniksued-rostock.de
Bernhardt
J
J
Steffen
H
H
Lorenz
D
D
D000714:Anastomosis, Surgical / Q000379:methods; D002758:Cholangiography / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003135:Common Bile Duct / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000601:surgery*; D016343:Monitoring, Intraoperative / Q000379:methods*; D016896:Treatment Outcome