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Does routine intraoperative cholangiography prevent bile duct transection?

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Abstract

Background

The role of routine intraoperative cholangiography is controversial. The aim of this study was to assess the impact of routine intraoperative cholangiography on the incidence of common bile duct injuries, and to evaluate the operative outcome of laparoscopic cholecystectomy carried out in a major teaching hospital and review the literature.

Methods

Prospectively collected data on 3,145 laparoscopic cholecystectomies performed mainly by surgical trainees in the period 1990 to 2002 using routine intraoperative cholangiography with fluoroscopy were reviewed.

Results

The mean age of the study sample (65.6% male, 34.4% female) was 54 years, and 16.9% of the patients had clinical acute cholecystitis. The conversion rate to open cholecystectomy was 4.3%. Intraoperative cholangiography was attempted for 90.7% of the patients with a 95.9% success rate. Five patients (0.16%) had common bile duct injuries. Four injuries had occurred in the first 5 years. One injury (0.06%) had occurred after 1995. This injury was identified intraoperatively and repaired laparoscopically. Routine intraoperative cholangiography prevented one definite common bile duct transection.

Conclusions

In this series using routine intraoperative cholangiography, there was a low rate and severity of common bile duct injuries, with a high intraoperative recognition rate. There was no bile duct transection or major injury requiring common bile duct reconstruction. Although intraoperative cholangiography helped in the immediate identification of injuries and the institution of appropriate therapy, injury was not completely prevented.

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References

  1. SB Archer DW Brown CD Smith GD Branum JG Hunter (2001) ArticleTitleBile duct injury during laparoscopic cholecystectomy: results of a national survey Ann Surg 234 549–558

    Google Scholar 

  2. LT Wit ParticleDe EA Rauws DJ Gouma (1999) ArticleTitleSurgical management of iatrogenic bile duct injury Scand J Gastroenterol Suppl 230 89–94 Occurrence Handle10499468

    PubMed  Google Scholar 

  3. DJ Deziel KW Millikan SG Economou A Doolas ST Ko MC Airan (1993) ArticleTitleComplications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases Am J Surg 165 9–14 Occurrence Handle8418705

    PubMed  Google Scholar 

  4. DR Fletcher MST Hobbs P Tan LJ Valinsky HR L. TJ Pikora MW Knuiman HJ Sheiner A Edis (1999) ArticleTitleComplications of cholecystectomy: risks of laparoscopic approach and protective effects of operative cholangiography: a population-based study Ann Surg 229 449–457 Occurrence Handle1:STN:280:DyaK1M3hslOhtw%3D%3D

    CAS  Google Scholar 

  5. DR Flum EP Dellinger A Cheadle L Chan T Koepsell (2003) ArticleTitleIntraoperative cholangiography and risk of common bile duct injury during cholecystectomy JAMA 289 1639–1644 Occurrence Handle10.1001/jama.289.13.1639 Occurrence Handle12672731

    Article  PubMed  Google Scholar 

  6. DR Flum T Koepsell P Heagerty M Sinanan EP Dellinger (2001) ArticleTitleCommon bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error? Arch Surg 136 1287–1292 Occurrence Handle10.1001/archsurg.136.11.1287 Occurrence Handle1:STN:280:DC%2BD38%2FivVKjsA%3D%3D Occurrence Handle11695975

    Article  CAS  PubMed  Google Scholar 

  7. DJ Gouma H Obertop (2002) ArticleTitleManagement of bile duct injuries: treatment and long-term results Dig Surg 19 117–122 Occurrence Handle10.1159/000052024 Occurrence Handle1:STN:280:DC%2BD383ktVynsQ%3D%3D Occurrence Handle11978998

    Article  CAS  PubMed  Google Scholar 

  8. TB Hugh (2002) ArticleTitleLaparoscopic bile duct injury: some myths ANZ J Surg 72 164–167 Occurrence Handle10.1046/j.1445-2197.2002.02311.x Occurrence Handle12074074

    Article  PubMed  Google Scholar 

  9. L Krahenbuhl G Sclabas MN Wente M Schafer R Schlumpf MW Buchler (2001) ArticleTitleIncidence, risk factors, and prevention of biliary tract injuries during laparoscopic cholecystectomy in Switzerland World J Surg 25 1325–1330 Occurrence Handle10.1007/s00268-001-0118-0 Occurrence Handle1:STN:280:DC%2BD3MrltVKqtA%3D%3D Occurrence Handle11596898

    Article  CAS  PubMed  Google Scholar 

  10. E Kullman K Borch E Lindstrom J Svanvik B Anderberg (1996) ArticleTitleValue of routine intraoperative cholangiography in detecting aberrant bile ducts and bile duct injuries during laparoscopic cholecystectomy Br J Surg 83 171–175 Occurrence Handle10.1046/j.1365-2168.1996.02190.x Occurrence Handle1:STN:280:BymB2cnpsFM%3D Occurrence Handle8689155

    Article  CAS  PubMed  Google Scholar 

  11. K Ludwig J Bernhardt D Lorenz (2002) ArticleTitleValue and consequences of routine intraoperative cholangiography during cholecystectomy Surg Laparosc Endosc Percutan Tech 12 154–159 Occurrence Handle10.1097/00129689-200206000-00003 Occurrence Handle12080254

    Article  PubMed  Google Scholar 

  12. K Ludwig J Bernhardt H Steffen D Lorenz (2002) ArticleTitleContribution of intraoperative cholangiography to incidence and outcome of common bile duct injuries during laparoscopic cholecystectomy Surg Endosc 16 1098–1104 Occurrence Handle10.1007/s00464-001-9183-6 Occurrence Handle1:STN:280:DC%2BD38vhtFGjsQ%3D%3D Occurrence Handle12165830

    Article  CAS  PubMed  Google Scholar 

  13. K Ludwig D Lorenz F Koeckerling (2002) ArticleTitleSurgical strategies in the laparoscopic therapy of cholecystolithiasis and common duct stones ANZ J Surg 72 547–552 Occurrence Handle10.1046/j.1445-2197.2002.02480.x Occurrence Handle12190725

    Article  PubMed  Google Scholar 

  14. BV MacFadyen SuffixJr R Vecchio AE Ricardo CR Mathis (1998) ArticleTitleBile duct injury after laparoscopic cholecystectomy: the United States experience Surg Endosc 12 315–321 Occurrence Handle9543520

    PubMed  Google Scholar 

  15. RF Martin RL Rossi (1994) ArticleTitleBile duct injuries: spectrum, mechanisms of injury, and their prevention Surg Clin North Am 74 781–803 Occurrence Handle1:STN:280:ByuA38zosVQ%3D Occurrence Handle8047942

    CAS  PubMed  Google Scholar 

  16. B Millat A Deleuze B Saxce Particlede C Seguin Particlede A Fingerhut (1997) ArticleTitleRoutine intraoperative cholangiography is feasible and efficient during laparoscopic cholecystectomy Hepatogastroenterology 44 22–27 Occurrence Handle1:STN:280:ByiB3M7htFE%3D Occurrence Handle9058113

    CAS  PubMed  Google Scholar 

  17. YD Pondos DV Gelfand TS Dulkanchainun SE Wilson S Cao P Ji JA Ortiz DK Imagawa (2001) ArticleTitleIs intraoperative cholangiography during laparoscopic cholecystectomy cost effective? Am J Surg 182 663–669 Occurrence Handle10.1016/S0002-9610(01)00808-X Occurrence Handle11839335

    Article  PubMed  Google Scholar 

  18. MC Richardson G Bell GM Fullarton WoSLCA Group (1996) ArticleTitleIncidence and nature of bile duct injuries following laparoscopic cholecystectomy: an audit of 5,913 cases Br J Surg 83 1356–1360 Occurrence Handle1:STN:280:ByiD1MbovVU%3D Occurrence Handle8944450

    CAS  PubMed  Google Scholar 

  19. RJ Rosenthal SD Steigerwald R Imig H Bockhorn (1994) ArticleTitleRole of intraoperative cholangiography during endoscopic cholecystectomy Surg Laparosc Endosc 4 171–174 Occurrence Handle1:STN:280:ByuA3MblsF0%3D Occurrence Handle8044357

    CAS  PubMed  Google Scholar 

  20. SJ Savader KD Lillemoe CA Prescott AB Winick AC Venbrux GB Lund SE Mitchell JL Cameron FA Osterman (1997) ArticleTitleLaparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster Ann Surg 225 268–273

    Google Scholar 

  21. K Slater RW Strong DR Wall SV Lynch (2002) ArticleTitleIatrogenic bile duct injury: the scourge of laparoscopic cholecystectomy ANZ J Surg 72 83–88 Occurrence Handle10.1046/j.1445-2197.2002.02315.x Occurrence Handle1:STN:280:DC%2BD38zjtVeksg%3D%3D Occurrence Handle12074081

    Article  CAS  PubMed  Google Scholar 

  22. SM Strasberg (1997) ArticleTitleCholelithiasis and acute cholecystitis Bailliers Clin Gastroenterol 11 643–661 Occurrence Handle10.1016/S0950-3528(97)90014-2 Occurrence Handle1:STN:280:DyaK1c7ntl2muw%3D%3D

    Article  CAS  Google Scholar 

  23. SM Strasberg H Martin NJ Soper (1995) ArticleTitleAn analysis of the problem of biliary injury during laparoscopic cholecystectomy J Am Coll Surg 180 101–125 Occurrence Handle1:STN:280:ByqD1Mznt10%3D Occurrence Handle8000648

    CAS  PubMed  Google Scholar 

  24. R Vecchio BV MacFadyen AE Ricardo (1998) ArticleTitleBile duct injury: management options during and after gallbladder surgery Semin Laparosc Surg 5 135–144 Occurrence Handle1:STN:280:DyaK1c3lvFSqug%3D%3D Occurrence Handle9594041

    CAS  PubMed  Google Scholar 

  25. KD Wright JM Wellwood (1998) ArticleTitleBile duct injury during laparoscopic cholecystectomy without operative cholangiography Br J Surg 85 191–194 Occurrence Handle10.1046/j.1365-2168.1998.00568.x Occurrence Handle1:STN:280:DyaK1c7mt1Cgtg%3D%3D Occurrence Handle9501813

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

The authors thank Debra Shearer for her help with data collection.

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Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, The University of Sydney, Hospital Road, Sydney, NSW, 2139, Australia

    E. Debru, A. Dawson, S. Leibman, M. Richardson, L. Glen, J. Hollinshead & G. L. Falk

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  1. E. Debru
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  2. A. Dawson
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  3. S. Leibman
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  4. M. Richardson
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  5. L. Glen
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  6. J. Hollinshead
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  7. G. L. Falk
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Corresponding author

Correspondence to G. L. Falk.

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Debru, E., Dawson, A., Leibman, S. et al. Does routine intraoperative cholangiography prevent bile duct transection?. Surg Endosc 19, 589–593 (2005). https://doi.org/10.1007/s00464-004-8711-6

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  • DOI: https://doi.org/10.1007/s00464-004-8711-6

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