Intraoperative Cholangiography Does Not Reduce Common Duct Injuries

Intraoperative cholangiography is not effective in preventing common duct injuries during cholecystectomy, according to a study published in The Journal of the American Medical Association.

In an effort to reduce injuries to the common hepatic duct or common bile duct that remain in the 0.3 percent to 0.5 percent range during cholecystectomy, investigators from the University of Texas sought to evaluate the usefulness of intraoperative cholangiography.

The retrospective study identified 92,932 Medicare beneficiaries from 307 hospitals in Texas, ages 66 years or older, who underwent inpatient or outpatient cholecystectomy for biliary colic or biliary dyskinesia, acute cholecystitis, or chronic cholecystitis between 2001 and 2009. There were a total of 37,533 cholecystectomies with intraoperative colangiography (40.4 percent) and 55,399 without (59.6 percent).

The researchers found the common duct injury rate was 0.21 percent (79 injuries) among the patients with intraoperative cholangiography and 0.36 percent (201 injuries) among patients without it.

"In a logistic regression model controlling for patient, surgeon, and hospital characteristics, the odds of common duct injury for cholecystectomies performed without intraoperative cholangiography were increased compared with those performed with it,” the authors wrote. “When confounding was controlled with instrumental variable analysis, the association between cholecystectomy performed without intraoperative cholangiography and duct injury was no longer significant."

The authors concluded, based on these results, “[r]outine intraoperative cholangiography should not be advocated as means for preventing common duct injury.”