title: Routine on-table cholangiography during cholecystectomy: a systematic review.
abstract: BACKGROUND
  The aim of this review was to systemically analyse trials evaluating the efficacy of routine on-table cholangiography (R-OTC) versus no on-table cholangiography (N-OTC) in patients undergoing cholecystectomy.
  
  
  METHODS
  Randomised trials evaluating R-OTC versus N-OTC in patients undergoing cholecystectomy were selected and analysed.
  
  
  RESULTS
  Four trials (1 randomised controlled trial on open cholecystectomy and 3 on laparoscopic cholecystectomy) encompassing 860 patients undergoing cholecystectomy with and without R-OTC were retrieved. There were 427 patients in the R-OTC group and 433 patients in the N-OTC group. There was no significant heterogeneity among trials. Therefore, in the fixed effects model, N-OTC did not increase the risk (p=0.53) of common bile duct (CBD) injury, and it was associated with shorter operative time (p<0.00001) and fewer peri-operative complications (p<0.04). R-OTC was superior in terms of peri-operative CBD stone detection (p<0.006) and it reduced readmission (p<0.03) for retained CBD stones.
  
  
  CONCLUSIONS
  N-OTC is associated with shorter operative time and fewer peri-operative complications, and it is comparable to R-OTC in terms of CBD injury risk during cholecystectomy. R-OTC is helpful for peri-operative CBD stone detection and there is therefore reduced readmission for retained CBD stones. The N-OTC approach may be adopted routinely for patients undergoing laparoscopic cholecystectomy providing there are no clinical, biochemical or radiological features suggestive of CBD stones. However, a major multicentre randomised controlled trial is required to validate this conclusion.
authors.affiliation: Western Sussex Hospitals NHS Trust, UK. surgeon1wrh@hotmail.com
authors.forename: M S
authors.initials: MS
authors.lastname: Sajid
authors.forename: C
authors.initials: C
authors.lastname: Leaver
authors.forename: Z
authors.initials: Z
authors.lastname: Haider
authors.forename: T
authors.initials: T
authors.lastname: Worthington
authors.forename: N
authors.initials: N
authors.lastname: Karanjia
authors.forename: K K
authors.initials: KK
authors.lastname: Singh
mesh_terms: D002758:Cholangiography / Q000379:methods*; D002763:Cholecystectomy / Q000379:methods*; D003135:Common Bile Duct / Q000293:injuries; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008136:Longevity; D010359:Patient Readmission; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence