title: Predictive value and main determinants of abnormal features of intraoperative cholangiography during cholecystectomy.
abstract: BACKGROUND
  The major issue with intraoperative cholangiography (IOC) is whether its diagnostic accuracy for common bile duct (CBD) stones matches that of other diagnostic procedures, and thus, whether it will become a routine diagnostic procedure. The current study aimed to address the main determinants of CBD stone diagnosis in IOC among an Iranian population.
  
  
  METHODS
  In a retrospective review database-based study conducted in Taleghani Hospital in Tehran between 2006 and 2008, baseline data and perioperative information of 2060 patients (male to female ratio 542:1518, mean age 53.7 years) who were candidates for cholecystectomy and underwent concomitant IOC for confirming CBD stones were reviewed. The predictive power of this procedure for diagnosis of abnormal biliary ducts with the focus on biliary stones was determined.
  
  
  RESULTS
  Overall mortality and morbidity following cholecystectomy in the study population were 0.6% and 2.6%, respectively. Both early mortality and morbidity due to cholecystectomy were higher in male than female. The prevalence of CBD stones in IOC was 3.4% (5.2% in male and 2.8% in female, P=0.008). Among those without gallstones, 8.7% had CBD stones and only 3.1% had concomitant gallstones and CBD stones. The main predictors of stone appearance as an abnormal feature of IOC during cholecystectomy were: advanced age (OR=1.022, P=0.001), male gender (OR=1.498, P=0.050), history of abdominal surgery (OR=1.543, P=0.040) and preoperative endoscopic retrograde cholangiopancreatography (OR=5.400, P<0.001).
  
  
  CONCLUSIONS
  IOC is a safe and accurate method for the assessment of bile duct anatomy and stones. Therefore, the routine use of IOC within cholecystectomy seems reasonable and is recommended.
authors.affiliation: Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Yousefpour Azary
authors.forename: Heshmat
authors.initials: H
authors.lastname: Kalbasi
authors.forename: Ali
authors.initials: A
authors.lastname: Setayesh
authors.forename: Mirhadi
authors.initials: M
authors.lastname: Mousavi
authors.forename: Asad
authors.initials: A
authors.lastname: Hashemi
authors.forename: Mahsa
authors.initials: M
authors.lastname: Khodadoostan
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Zali
authors.forename: Amir Houshang
authors.initials: AH
authors.lastname: Mohammad Alizadeh
mesh_terms: D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002758:Cholangiography; D002763:Cholecystectomy / Q000009:adverse effects / Q000401:mortality; D042883:Choledocholithiasis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D007492:Iran; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome