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Review
. 2020 Aug 15:3:8-15.
doi: 10.1016/j.sopen.2020.07.004. eCollection 2021 Jan.

A meta-analysis of the use of intraoperative cholangiography; time to revisit our approach to cholecystectomy?

Eoin Donnellan  1   2 , Jonathan Coulter  1   3 , Cherian Mathew  1   2 , Michelle Choynowski  1 , Louise Flanagan  3 , Magda Bucholc  4 , Alison Johnston  1 , Michael Sugrue  1   3
Affiliations
Review

A meta-analysis of the use of intraoperative cholangiography; time to revisit our approach to cholecystectomy?

Eoin Donnellan et al. Surg Open Sci. .

Abstract

Background: Despite some evidence of improved survival with intraoperative cholangiography during cholecystectomy, debate has raged about its benefit, in part because of its questionable benefit, time, and resources required to complete.

Methods: An International Prospective Register of Systematic Reviews-registered (ID CRD42018102154) meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Scopus, Web of Science, and Cochrane library from 2003 to 2018 was undertaken including search strategy "intraoperative AND cholangiogra* AND cholecystectomy." Articles scoring ≥ 16 for comparative and ≥ 10 for noncomparative using the Methodological Index for Non-Randomized Studies criteria were included. A dichotomous random effects meta-analysis using the Mantel-Haenszel method performed on Review Manager Version 5.3 was carried out.

Results: Of 2,059 articles reviewed, 62 met criteria for final analysis. The mean rate of intraoperative cholangiography was 38.8% (range 1.6%-96.4%).There was greater detection of bile duct stones during cholecystectomy with routine intraoperative cholangiography compared with selective intraoperative cholangiography (odds ratio = 3.28, confidence interval = 2.80-3.86, P value < .001). While bile duct injury during cholecystectomy was less with intraoperative cholangiography (0.39%) than without intraoperative cholangiography (0.43%), it was not statistically significant (odds ratio = 0.88, confidence interval = 0.65-1.19, P value = .41). Readmission following cholecystectomy with intraoperative cholangiography was 3.0% compared to 3.5% without intraoperative cholangiography (odds ratio = 0.91, confidence interval = 0.78-1.06, P value = .23).

Conclusion: The use of intraoperative cholangiography still has its place in cholecystectomy based on the detection of choledocholithiasis and the potential reduction of unfavorable outcomes associated with common bile duct stones. This meta-analysis, the first to review intraoperative cholangiography use, identified a marked variation in cholangiography use. Retrospective studies limit the ability to critically define association between intraoperative cholangiography use and bile duct injury.

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Figures

Fig 1
Fig 1
Identification, review, and selection of articles included in the meta-analysis, shown by PRISMA flowchart.
Fig 2
Fig 2
The rate of IOC during cholecystectomy, reported from 56 studies.
Fig 3
Fig 3
The rate of biliary injury during cholecystectomy with routine IOC versus selective IOC.
Fig 4
Fig 4
The rate of biliary injury during cholecystectomy with IOC versus without IOC.
Fig 5
Fig 5
The rate of readmission following cholecystectomy with IOC versus without IOC.
See this image and copyright information in PMC

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