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Intraoperative cholangiography: a stepping stone to streamlining the treatment of choledocholithiasis

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Abstract

Background

An estimated 8–15% of patients undergoing cholecystectomy have concomitant common bile duct stones. In this 14-year study, we utilize data of patients at a high-volume tertiary care academic center and compare the clinical outcomes of patients undergoing intraoperative cholangiography (IOC) and endoscopic retrograde pancreatography (ERCP).

Methods

The charts of 1715 patients in the institutional NSQIP database who underwent cholecystectomy between October 1st, 2005 and September 30th, 2019 were retrospectively reviewed. Patients who underwent cholecystectomy in relation to a malignancy diagnosis or who underwent an ERCP in a different index hospitalization were excluded. Main outcomes included hospital length of stay (LOS), post-operative morbidity, and rate of readmissions.

Results

Of the 1409 patients included in the final analysis, 185 patients underwent ERCP, while 95 patients underwent IOC. Use of IOC compared to preoperative ERCP resulted in a shorter LOS (2.6 vs. 5.3 days, p < 0.001), lower rate of readmission (1.1% vs. 6.5%, p = 0.040), and similar rates of post-operative complications. Mean operative time increased by only 15 min in the IOC compared to the ERCP group (129 vs.114 min, p = 0.047). Additional variables that increased LOS on multivariable logistic regression included age, ASA classification, post-operative complications, and increased number of preoperative tests.

Conclusions

This study demonstrates that use of IOC during cholecystectomy results in shorter LOS and fewer readmissions compared to ERCP. Future studies comparing these two approaches should focus on patient randomization, a cost-effectiveness analysis, and identifying barriers to implementation of a one-stage approach in the management of suspected choledocholithiasis.

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Acknowledgements

The authors would like to acknowledge Mary Beth Cotter for her assistance in acquiring the data used in this study and whose diligent efforts made this study possible.

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Author notes

  1. Nisha Narula

    Present address: Staten Island University Hospital, 256 Mason Avenue, Staten Island, NY, 10305, USA

Authors and Affiliations

  1. Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 2G, Boston, MA, 02215, USA

    Savas Tsikis, Stephen R. Odom & Nisha Narula

  2. Harvard Medical School, Boston, MA, USA

    Sophia H. Yin

Authors
  1. Savas Tsikis
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  2. Sophia H. Yin
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Correspondence to Nisha Narula.

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Savas Tsikis, Sophia H. Yin, Stephen R. Odom, and Nisha Narula have no disclosures or conflicts of interest to report.

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Tsikis, S., Yin, S.H., Odom, S.R. et al. Intraoperative cholangiography: a stepping stone to streamlining the treatment of choledocholithiasis. Surg Endosc 36, 4885–4892 (2022). https://doi.org/10.1007/s00464-021-08840-0

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  • DOI: https://doi.org/10.1007/s00464-021-08840-0

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