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Use of Intra-Op Cholangiography in Cholecystectomy Questioned

Use of Intra-Op Cholangiography in Cholecystectomy Questioned

After controlling for confounding, no reduction in common duct injuries observed

TUESDAY, Aug. 27 (HealthDay News) -- Intraoperative cholangiography does not prevent common duct injury during cholecystectomy, according to a study published in the Aug. 28 issue of the Journal of the American Medical Association.

Kristin M. Sheffield, Ph.D., of the University of Texas Medical Branch in Galveston, and colleagues conducted a retrospective cohort study using data from all Texas Medicare claims for cholecystectomy in patients aged 66 years or older from 2000 to 2009 to assess the association between intraoperative cholangiography and common duct injury.

The researchers found that 37,533 (40.4 percent) of 92,932 patients undergoing cholecystectomy had concurrent intraoperative cholangiography. Common duct injury occurred in 0.21 percent of patients undergoing surgery with intraoperative cholangiography and in 0.36 percent of patients undergoing surgery without it. Using a logistic regression model controlling for patient, surgery, and hospital characteristics, common duct injury was significantly more likely without intraoperative cholangiography than with it (odds ratio, 1.79). Using instrumental variable analysis to control for confounding, this association was not significant (odds ratio, 1.26; P = 0.31).

"While the true effect of intraoperative cholangiography on the safety of laparoscopic cholecystectomy remains controversial, this study will undoubtedly reinvigorate the discussion," write the authors of an accompanying editorial.

Abstract (http://jama.jamanetwork.com/article.aspx?articleid=1733717#Abstract )Full Text (subscription of payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1733717 )Editorial (subscription of payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1733697 )