Selective intraoperative cholangiography and risk of bile duct injury during cholecystectomy.
BACKGROUND
Whether intraoperative cholangiography can prevent iatrogenic bile duct injury during cholecystectomy remains controversial.


METHODS
Data from the national Swedish Registry for Gallstone Surgery, GallRiks (May 2005 to December 2010), were analysed for evidence of iatrogenic bile duct injury during cholecystectomy. Patient- and procedure-related risk factors for bile duct injury with a focus on the rate of intended intraoperative cholangiography were analysed using multivariable logistic regression.


RESULTS
A total of 51 041 cholecystectomies and 747 bile duct injuries (1·5 per cent) were identified; 9008 patients (17·6 per cent) were diagnosed with acute cholecystitis. No preventive effect of intraoperative cholangiography was seen in uncomplicated gallstone disease (odds ratio (OR) 0·97, 95 per cent c.i. 0·74 to 1·25). Operating in the presence (OR 1·23, 1·03 to 1·47) or a history (OR 1·34, 1·10 to 1·64) of acute cholecystitis, and open surgery (OR 1·56, 1·26 to 1·94), were identified as significant risk factors for bile duct injury. The intention to perform intraoperative cholangiography was associated with a reduced risk of bile duct injury in patients with concurrent (OR 0·44, 0·30 to 0·63) or a history of (OR 0·59, 0·35 to 1·00) acute cholecystitis.


CONCLUSIONS
Any proposed protective effect of intraoperative cholangiography was restricted to patients with (or a history of) acute cholecystitis.
Department of Clinical Science, Intervention and Technology, Division of Surgery, Solna, Karolinska Institutet, Stockholm, Sweden.
B
B
Törnqvist
Department of Clinical Science, Intervention and Technology, Division of Surgery, Solna, Karolinska Institutet, Stockholm, Sweden.
C
C
Strömberg
Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
O
O
Akre
Department of Clinical Science, Intervention and Technology, Division of Surgery, Solna, Karolinska Institutet, Stockholm, Sweden.
L
L
Enochsson
Department of Clinical Science, Intervention and Technology, Division of Surgery, Solna, Karolinska Institutet, Stockholm, Sweden.
M
M
Nilsson
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries*; D002758:Cholangiography; D002763:Cholecystectomy / Q000009:adverse effects*; D002764:Cholecystitis / Q000601:surgery; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012307:Risk Factors