This article is more than 5 years old. Information may no longer be current.

No link between intraoperative cholangiography, common duct injury during cholecystectomy

Intraoperative cholangiography performed during cholecystectomy did not impact risk for common duct injury in a recent retrospective cohort study.

Researchers evaluated data collected from 92,932 Medicare beneficiaries in Texas aged 66 years or older who submitted claims for cholecystectomy for acute or chronic cholecystitis or biliary colic or dyskinesia between 2001 and 2009. Patients were considered to have major common duct injury if a claim was submitted for a common duct repair operation within 1 year of cholecystectomy.

Concurrent intraoperative cholangiography (IC) was performed in 40.4% of the cohort, and 0.3% experienced a common duct injury. Patients who did not undergo IC had a higher injury rate than those who did (0.36% of cases vs. 0.21%). When treated in hospitals that regularly performed IC, those who did not receive the procedure were significantly more likely to experience injury (0.76% of nonrecipients vs. 0.12), while injury was more common among IC recipients when treated in facilities that did not regularly perform the procedure (0.25% of nonrecipients vs. 0.96%) (P<.001 for both).

The difference in risk between the two groups was statistically significant in logistic regression analysis adjusting for confounders related to the patient, the facility at which they were treated and the surgeon performing the procedure, as well as for patient clustering within hospitals (OR=1.79, 1.35-2.36) However, instrumental variable analysis controlling for suspected unmeasured confounders eliminated this significance when using either the percentage of IC performed by the hospital (OR=1.26, 0.81-1.96) or the surgeon (OR=1.31, 0.91-1.89) as the instrumental variable (95% CI for all).

“Significant controversy exists regarding the role of intraoperative cholangiography in the prevention of common duct injury during cholecystectomy,” the researchers wrote. “In the present study … the association between intraoperative cholangiography and common duct injury was highly sensitive to the analytic method used. … Our results demonstrate that the estimated association between intraoperative cholangiography and common duct injury in previous studies is possibly attributable to unmeasured confounding. … Based on these results, routine intraoperative cholangiography should not be advocated as [a] means for preventing common duct injury.”

Disclosure: Researcher Yong-Fang Kuo, PhD, reports a pending grant with the Agency for Healthcare Research and Quality.