Abstract:
Background: Intraoperative cholangiography (IOC) is commonly employed during laparoscopic cholecystectomy to delineate biliary anatomy and detect choledocholithiasis. IOC interpretation may be performed by the operating surgeon or a radiologist, but the comparative effects on efficiency, diagnostic accuracy, and patient safety are uncertain.
Method: All laparoscopic cholecystectomies recorded in the Swedish National Register for Gallstone Surgery (GallRiks) between 2009 and 2020 were analysed. Institutional IOC protocols were identified through a supplementary survey of participating clinics. Registry data were linked to survey responses, and outcomes were assessed using mixed?effects models and logistic regression. The primary endpoint was operating time; secondary endpoints included detection of common bile duct stones (CBDS), intraoperative and postoperative complications, and bile duct injury.
Results: A total of 118,556 procedures across 61 clinics were included. Radiologist-led IOC interpretation was associated with longer operating times (mean difference of 11.3 minutes; 95% CI 1.60–20.89) compared with surgeon-led interpretation. Detection rates for CBDS were similar (12.6% vs. 12.4%; OR 0.95, 95% CI 0.90–0.99). Intraoperative complications occurred more frequently with radiologist interpretation (2.6% vs. 1.5%; OR 0.58, 95% CI 0.52–0.63), whereas postoperative complications were slightly more common with surgeon interpretation (8.2% vs. 7.3%; OR 1.14, 95% CI 1.08–1.20). Bile duct injury rates were identical at 0.3% in both groups (OR 1.0, 95% CI 0.79–1.27).
Conclusion: Surgeon-led IOC interpretation reduces operating time and represents a safe, resource-efficient strategy without increasing the risk of bile duct injury. These findings support surgeon interpretation as the default approach.
Biography:
To be updated shortly..
Copyright 2024 Mathews International LLC All Rights Reserved
