Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Aug 28;310(8):812-20.
doi: 10.1001/jama.2013.276205.

Association between cholecystectomy with vs without intraoperative cholangiography and risk of common duct injury

Kristin M Sheffield  1 , Taylor S Riall, Yimei Han, Yong-Fang Kuo, Courtney M Townsend Jr, James S Goodwin
Affiliations

Association between cholecystectomy with vs without intraoperative cholangiography and risk of common duct injury

Kristin M Sheffield et al. JAMA. .

Abstract

Importance: Significant controversy exists regarding routine intraoperative cholangiography in preventing common duct injury during cholecystectomy.

Objective: To investigate the association between intraoperative cholangiography use during cholecystectomy and common duct injury.

Design, setting, and participants: Retrospective cohort study of all Texas Medicare claims data from 2000 through 2009. We identified Medicare beneficiaries 66 years or older who underwent inpatient or outpatient cholecystectomy for biliary colic or biliary dyskinesia, acute cholecystitis, or chronic cholecystitis. We compared results from multilevel logistic regression models to the instrumental variable analyses.

Interventions: Intraoperative cholangiography use during cholecystectomy was determined at the level of the patients (yes/no), hospitals (percentage intraoperative cholangiography use for all cholecystectomies at the hospital), and surgeons (percentage use for all cholecystectomies performed by the surgeon). Percentage of use at the hospital and percentage of use by surgeon were the instrumental variables.

Main outcomes and measures: Patients with claims for common duct repair operations within 1 year of cholecystectomy were considered as having major common duct injury.

Results: Of 92,932 patients undergoing cholecystectomy, 37,533 (40.4%) underwent concurrent intraoperative cholangiography and 280 (0.30%) had a common duct injury. The common duct injury rate was 0.21% among patients with intraoperative cholangiography and 0.36% 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 (OR, 1.79 [95% CI, 1.35-2.36]; P < .001). When confounding was controlled with instrumental variable analysis, the association between cholecystectomy performed without intraoperative cholangiography and duct injury was no longer significant (OR, 1.26 [95% CI, 0.81-1.96]; P = .31).

Conclusions and relevance: When confounders were controlled with instrumental variable analysis, there was no statistically significant association between intraoperative cholangiography and common duct injury. Intraoperative cholangiography is not effective as a preventive strategy against common duct injury during cholecystectomy.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Kuo reports a pending grant with the Agency for Healthcare Research and Quality. No other disclosures were reported.

Figures

Figure
Figure
Study Selection Summary.
See this image and copyright information in PMC

Comment in

References

    1. Barauskas G, Paškauskas S, Dambrauskas Z, Gulbinas A, Pundzius J. Referral pattern, management, and long-term results of laparoscopic bile duct injuries: a case series of 44 patients. Medicina (Kaunas) 2012;48(3):138–144. - PubMed
    1. Johnson SR, Koehler A, Pennington LK, Hanto DW. Long-term results of surgical repair of bile duct injuries following laparoscopic cholecystectomy. Surgery. 2000;128(4):668–677. - PubMed
    1. Lau WY, Lai EC, Lau SH. Management of bile duct injury after laparoscopic cholecystectomy: a review. ANZ J Surg. 2010;80(1–2):75–81. - PubMed
    1. Mercado MA, Franssen B, Dominguez I, et al. Transition from a low: to a high-volume centre for bile duct repair: changes in technique and improved outcome. HPB (Oxford) 2011;13(11):767–773. - PMC - PubMed
    1. Ozturk E, Can MF, Yagci G, et al. Management and mid- to long-term results of early referred bile duct injuries during laparoscopic cholecystectomy. Hepatogastroenterology. 2009;56(89):17–25. - PubMed

Publication types