Ashley L Deeb1, Yazen Qumsiyeh1, Sean Wrenn, MD2, Charles Maclean, MDCM, FACP3, Wasef Abu-Jaish, MD, FACS, FASMBS2. 1The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington VT, 2Department of Surgery, University of Vermont Medical Center, Burlington VT, 3Department of Medicine, University of Vermont Medical Center, Burlington VT
Introduction: The utility of intraoperative cholangiography (IOC) in reducing complications of cholecystectomy such as bile duct injury or retained stones has been controversial and surgeons still differ on routine use of IOC versus taking a selective approach. We sought to investigate whether use of IOC reduces the rate of complications after cholecystectomy, whether there is a difference in complication rates among surgeons who perform IOC routinely and those who perform IOC selectively, and whether IOC significantly increases operative time.
Methods: We conducted a single-center, retrospective chart review of 2,764 adult cholecystectomies performed between July 2009 and August 2016. Complications included the following: bile duct injury or leak, retained stones, deep site infection, biloma, other miscellaneous complications, or death. We compared the effect of IOC on the outcomes using Chi squared for the complication outcome and with Student’s t test for duration. We used logistic regression to determine the effect of IOC on outcomes while controlling for demographic characteristics, surgical urgency (elective versus urgent), and surgeon annual volume.
Results: Our study population was 69.9% female, with a median age of 50 years (range 18-95). 71.4% (N=1974) of cases were performed electively while 7.5% (N=207) were urgent and 21.1% (N=583) were emergent. Of the cohort, 35.1% (N=969) of patients were operated on by surgeons who perform IOC routinely (79.2% of these patients actually had an IOC) and 64.9% (N=1795) of patients were operated on by surgeons who perform IOC selectively (11% received an IOC).
The complication rate was similar amongst those with an IOC (1.9%, N=18) versus those without an IOC (2.3%, N=42) p=0.4. When analyzed according to the intention of the surgeon, the results were similar: routine IOC (1.6%, N=15 complications) versus selective IOC (2.5%, N=45 complications), p=0.10. Additionally, there was no significant influence of IOC on bile leak or retained stone rates whether the IOC was routine (1.4%, N=14) or selective (2.2%, N=39) (p=0.18). Similarly, logistic regression modelling showed no significant association between completed IOC and complications, (OR=0.77 95% CI .43, 1.38, p=0.4). Among open cases, performing IOC added 47.3 minutes to operating time (183.7 versus 136.4 minutes, p<0.001) and among laparoscopic cases, performing IOC added 13.1 minutes (89.9 versus 76.8 minutes, p<0.001).
Conclusions: Overall, performing an IOC, whether it is performed routinely or selectively, does not significantly influence complication rates. Additionally, performing an IOC added an average of 47 minutes to open cases and 13 minutes to laparoscopic cases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87071
Program Number: S016
Presentation Session: Biliary Session
Presentation Type: Podium