title: Routine intraoperative cholangiography is unnecessary in patients with mild gallstone pancreatitis and normalizing bilirubin levels.
abstract: BACKGROUND
  The benefit of intraoperative cholangiography (IOC) is controversial in patients with gallstone pancreatitis whose bilirubin levels are normalizing. IOC with subsequent endoscopic retrograde cholangiopancreatography may lengthen duration of surgery and length of stay, whereas failure to clear the common bile duct may result in recurrent pancreatitis.
  
  
  METHODS
  We performed a 6-year retrospective cohort analysis of consecutive adult patients with mild gallstone pancreatitis undergoing same-admission cholecystectomy at 2 university-affiliated medical centers. Institution A routinely performed IOC, whereas institution B did not. The primary outcome was readmission within 30 days for recurrent pancreatitis.
  
  
  RESULTS
  Of 520 patients evaluated, 246 (47%) were managed at institution A (routine IOC) and 274 (53%) were managed at institution B (restricted IOC). Patients at institution B had a shorter duration of surgery (1.0 vs 1.6 hours, P < .001), shorter length of stay (4 vs 5 days, P < .001), and fewer postoperative endoscopic retrograde cholangiopancreatographies performed (1.8% vs 21%, P < .001), without a difference in readmissions (1.5% vs 0%, P = .12).
  
  
  CONCLUSIONS
  Routine IOC is not necessary in the setting of mild gallstone pancreatitis with normalizing bilirubin values.
authors: Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90509, USA.
authors: Xuan-Binh D
authors: XD
authors: Pham
authors: Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90509, USA.
authors: Christian
authors: C
authors: de Virgilio
authors: David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors: Lutfi
authors: L
authors: Al-Khouja
authors: Meharry Medical College, Nashville, TN, USA.
authors: Michael C
authors: MC
authors: Bermudez
authors: Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90509, USA.
authors: Alexander C
authors: AC
authors: Schwed
authors: Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA.
authors: Amy H
authors: AH
authors: Kaji
authors: Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90509, USA.
authors: David S
authors: DS
authors: Plurad
authors: Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90509, USA.
authors: Steven L
authors: SL
authors: Lee
authors: Department of Surgery, Olive View-UCLA Medical Center, Sylmar, CA, USA.
authors: Robert S
authors: RS
authors: Bennion
authors: Department of Surgery, Olive View-UCLA Medical Center, Sylmar, CA, USA.
authors: Darin J
authors: DJ
authors: Saltzman
authors: Department of Surgery, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90509, USA. Electronic address: dekim@dhs.lacounty.gov.
authors: Dennis Y
authors: DY
authors: Kim
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D042882:Gallstones / Q000097:blood / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D012189:Retrospective Studies
chemical_list: D001663:Bilirubin
keywords: 30-Day readmission; Bilirubin; Endoscopic retrograde cholangiopancreatography; Gallstone pancreatitis; Intraoperative cholangiography