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. 2012 Oct 11:345:e6457.
doi: 10.1136/bmj.e6457.

Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study

Björn Törnqvist  1 , Cecilia Strömberg, Gunnar Persson, Magnus Nilsson
Affiliations

Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study

Björn Törnqvist et al. BMJ. .

Abstract

Objectives: To determine whether the routine use of intraoperative cholangiography can improve survival from complications related to bile duct injuries.

Design: Population based cohort study.

Setting: Prospectively collected data from the Swedish national registry of gallstone surgery and endoscopic retrograde cholangiopancreatography, GallRiks. Multivariate analysis done by Cox regression.

Population: All cholecystectomies recorded in GallRiks between 1 May 2005 and 31 December 2010.

Main outcome measures: Evidence of bile duct injury, rate of intended use of intraoperative cholangiography, and rate of survival after cholecytectomy.

Results: During the study, 51,041 cholecystectomies were registered in GallRiks and 747 (1.5%) iatrogenic bile duct injuries identified. Patients with bile duct injuries had an impaired survival compared with those without injury (mortality at one year 3.9% v 1.1%). Kaplan-Meier analysis showed that early detection of a bile duct injury, during the primary operation, improved survival. The intention to use intraoperative cholangiography reduced the risk of death after cholecystectomy by 62% (hazard ratio 0.38 (95% confidence interval 0.31 to 0.46)).

Conclusions: The high incidence of bile duct injury recorded is probably from GallRiks' ability to detect the entire range of injury severities, from minor ductal lesions to complete transections of major ducts. Patients with bile duct injury during cholecystectomy had impaired survival, and early detection of the injury improved survival. The intention to perform an intraoperative cholangiography reduced the risk of death after cholecystectomy.

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Conflict of interest statement

Funding: No external funding was used for this project.

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Ethical approval: The regional research ethics committee at Karolinska Institutet, Stockholm, Sweden, approved the study.

Figures

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Fig 1 Survival in patients after cholecystectomy, with and without bile duct injury
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Fig 2 Survival in patients after cholecystectomy, in relation to no injury and early and delayed detection of bile duct injury
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Fig 3 Survival in patients with iatrogenic bile duct injury during cholecystectomy, according to use of intraoperative cholangiography (IOC)
See this image and copyright information in PMC

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