Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Systematic intraoperative cholangiography during elective laparoscopic cholecystectomy: Is it a justifiable practice?

  • Francesco Esposito (Visceral and Digestive Surgery Unit, Grand Hopital de l'Est Francilien) ;
  • Iolanda Scoleri (Visceral and Digestive Surgery Unit, Grand Hopital de l'Est Francilien) ;
  • Rafika Cattan (Visceral and Digestive Surgery Unit, Grand Hopital de l'Est Francilien) ;
  • Marie Cecile Cook (Visceral and Digestive Surgery Unit, Grand Hopital de l'Est Francilien) ;
  • Dorin Sacrieru (Visceral and Digestive Surgery Unit, Grand Hopital de l'Est Francilien) ;
  • Nouredine Meziani (Visceral and Digestive Surgery Unit, Grand Hopital de l'Est Francilien) ;
  • Marco Del Prete (Visceral and Digestive Surgery Unit, Grand Hopital de l'Est Francilien) ;
  • Morad Kabbej (Visceral and Digestive Surgery Unit, Grand Hopital de l'Est Francilien)
  • Received : 2022.10.06
  • Accepted : 2022.11.24
  • Published : 2023.05.31
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Abstract

Backgrounds/Aims: Routine execution of intraoperative cholangiography (IOC) in laparoscopic cholecystectomy (LC) is considered a good practice to help early identification of biliary duct injuries (BDIs) or common bile duct (CBD) stones. This study aimed to determine the impact of IOC during LC. Methods: This is a retrospective, monocentric study, including patients with a LC performed from January 2020 to December 2021. Results: Of 303 patients, 215 (71.0%) were in the IOC group and 88 (29.0%) in the no-IOC group. IOC was incomplete or unclear in 10.7% of patients, with a failure rate of 14.7%. Operating time was 15 minutes longer in the IOC group (p = 0.01), and postoperative complications were higher (5.1% vs. 0.0%, p = 0.03). There were three BDIs (0.99%), all included in the IOC group; only one was diagnosed intraoperatively, and the other two were identified during the postoperative course. Regarding identifying CBD stones, IOC showed a sensitivity of 77%, a specificity of 98%, an accuracy of 97.2%, a positive predictive value of 63% and a negative predictive value of 99%. Conclusions: Systematic IOC has shown no specific benefits and prolonged operative duration. IOC should be performed on selected patients or in situations of uncertainty on the anatomy.

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References

  1. Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA 2003;290:2168-2173.  https://doi.org/10.1001/jama.290.16.2168
  2. Mangieri CW, Hendren BP, Strode MA, Bandera BC, Faler BJ. Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era. Surg Endosc 2019;33:724-730.  https://doi.org/10.1007/s00464-018-6333-7
  3. Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU). Intraoperative cholangiography in cholecystectomy: a systematic review and assessment of medical, economic, social and ethical aspects [Internet]. Stockholm: Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) 2018 [cited 2021 Jun 17]. Available from: https://pubmed.ncbi.nlm.nih.gov/34464042/. 
  4. Federation de chirurgie viscerale et digestive. Risk management to decrease bile duct injury associated with cholecystectomy: measures to improve patient safety. J Visc Surg 2014;151:241-244.  https://doi.org/10.1016/j.jviscsurg.2014.04.003
  5. Rystedt JML, Wiss J, Adolfsson J, Enochsson L, Hallerback B, Johansson P, et al. Routine versus selective intraoperative cholangiography during cholecystectomy: systematic review, meta-analysis and health economic model analysis of iatrogenic bile duct injury. BJS Open 2021;5:zraa032. 
  6. Ford JA, Soop M, Du J, Loveday BP, Rodgers M. Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg 2012;99:160-167.  https://doi.org/10.1002/bjs.7809
  7. Ding GQ, Cai W, Qin MF. Is intraoperative cholangiography necessary during laparoscopic cholecystectomy for cholelithiasis? World J Gastroenterol 2015;21:2147-2151.  https://doi.org/10.3748/wjg.v21.i7.2147
  8. Michael Brunt L, Deziel DJ, Telem DA, Strasberg SM, Aggarwal R, Asbun H, et al. Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy. Surg Endosc 2020;34:2827-2855.  https://doi.org/10.1007/s00464-020-07568-7
  9. Van Dijk AH, De Reuver PR, Besselink MG, Van Laarhoven KJ, Harrison EM, Wigmore SJ, et al. Assessment of available evidence in the management of gallbladder and bile duct stones: a systematic review of international guidelines. HPB (Oxford) 2017;19:297-309.  https://doi.org/10.1016/j.hpb.2016.12.011
  10. Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, et al. Laparoscopic cholecystectomy: consensus conference-based guidelines. Langenbecks Arch Surg 2015;400:429-453.  https://doi.org/10.1007/s00423-015-1300-4
  11. European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016;65:146-181.  https://doi.org/10.1016/j.jhep.2016.03.005
  12. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg 2010;211:132-138.  https://doi.org/10.1016/j.jamcollsurg.2010.02.053
  13. Amott D, Webb A, Tulloh B. Prospective comparison of routine and selective operative cholangiography. ANZ J Surg 2005;75:378-382.  https://doi.org/10.1111/j.1445-2197.2005.03393.x
  14. Fletcher DR, Hobbs MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ, et al. Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 1999;229:449-457.  https://doi.org/10.1097/00000658-199904000-00001
  15. Rhaiem R, Piardi T, Renard Y, Chetboun M, Aghaei A, Hoeffel C, et al. Preoperative magnetic resonance cholangiopancreatography before planned laparoscopic cholecystectomy: is it necessary? J Res Med Sci 2019;24:107. 
  16. Zang J, Yuan Y, Zhang C, Gao J. Elective laparoscopic cholecystectomy without intraoperative cholangiography: role of preoperative magnetic resonance cholangiopancreatography - a retrospective cohort study. BMC Surg 2016;16:45. 
  17. Joyce WP, Keane R, Burke GJ, Daly M, Drumm J, Egan TJ, et al. Identification of bile duct stones in patients undergoing laparoscopic cholecystectomy. Br J Surg 1991;78:1174-1176.  https://doi.org/10.1002/bjs.1800781008
  18. Williams E, Beckingham I, El Sayed G, Gurusamy K, Sturgess R, Webster G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut 2017;66:765-782.  https://doi.org/10.1136/gutjnl-2016-312317
  19. Hakuta R, Hamada T, Nakai Y, Oyama H, Kanai S, Suzuki T, et al. Natural history of asymptomatic bile duct stones and association of endoscopic treatment with clinical outcomes. J Gastroenterol 2020;55:78-85.  https://doi.org/10.1007/s00535-019-01612-7
  20. Conrad C, Wakabayashi G, Asbun HJ, Dallemagne B, Demartines N, Diana M, et al. IRCAD recommendation on safe laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci 2017;24:603-615.  https://doi.org/10.1002/jhbp.491
  21. de'Angelis N, Catena F, Memeo R, Coccolini F, Martinez-Perez A, Romeo OM, et al. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg 2021;16:30. 
  22. Goldstein SD, Lautz TB. Fluorescent cholangiography during laparoscopic cholecystectomy: shedding new light on biliary anatomy. JAMA Surg 2020;155:978-979.  https://doi.org/10.1001/jamasurg.2020.3003
  23. Lehrskov LL, Westen M, Larsen SS, Jensen AB, Kristensen BB, Bisgaard T. Fluorescence or X-ray cholangiography in elective laparoscopic cholecystectomy: a randomized clinical trial. Br J Surg 2020;107:655-661.  https://doi.org/10.1002/bjs.11510
  24. Dip F, LoMenzo E, Sarotto L, Phillips E, Todeschini H, Nahmod M, et al. Randomized trial of near-infrared incisionless fluorescent cholangiography. Ann Surg 2019;270:992-999.  https://doi.org/10.1097/SLA.0000000000003178
  25. Hauer-Jensen M, Karesen R, Nygaard K, Solheim K, Amlie EJ, Havig O, et al. Prospective randomized study of routine intraoperative cholangiography during open cholecystectomy: long-term follow-up and multivariate analysis of predictors of choledocholithiasis. Surgery 1993;113:318-323. 
  26. Murison MS, Gartell PC, McGinn FP. Does selective peroperative cholangiography result in missed common bile duct stones? J R Coll Surg Edinb 1993;38:220-224.