Abstract
BackgroundThe role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the present study was to evaluate the feasibility, benefit and risk of performing systematic IOC in patients undergoing cholecystectomy for acute gallstone-related disease.MethodsBetween July 2013 and January 2015, all patients admitted for an acute gallstone-related condition and undergoing same-hospital-stay cholecystectomy were prospectively followed. IOC was systematically attempted and predictors of IOC failure were analyzed.ResultsAmong the 581 enrolled patients, IOC was deliberately not performed in 3 cases. IOC was successful in 509/578 patients (88.1%). The main predictors of IOC failure were age, body mass index, male gender and associated acute cholecystitis. Thirty-two patients with suspected common bile duct stone on IOC underwent 38 unnecessary negative postoperative common bile duct investigations (32/509, 6.3%). There was one IOC-related adverse outcome (mild pancreatitis, 1/578, 0.2%).ConclusionsIOC can be successfully and safely performed in the majority of patients undergoing cholecystectomy for acute gallstone-related disease. Although its positive predictive value is suboptimal and results in a number of unnecessary postoperative common bile duct investigations, IOC accurately rules out common bile duct stones in patients with acute gallstone-related conditions.
Highlights
Acute gallstone-related disease represents a heavy burden in terms of financial cost, and number of emergency room visits, accounting for more than one million urgent medical consultations in the United States yearly [1,2]
Its positive predictive value is suboptimal and results in a number of unnecessary postoperative common bile duct investigations, intraoperative cholangiogram (IOC) accurately rules out common bile duct stones in patients with acute gallstone-related conditions
Patients presenting to the emergency room with an acute gallstone-related disease were classified according to the American Society for Gastrointestinal Endoscopy (ASGE)/Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines [12] as low, intermediate- and high-risk of presenting a common bile duct (CBD) stone
Summary
Acute gallstone-related disease represents a heavy burden in terms of financial cost, and number of emergency room visits, accounting for more than one million urgent medical consultations in the United States yearly [1,2]. IOC allows for the identification of CBD stones, the early detection of biliary lesions and, for some authors, a decreased readmission rate after cholecystectomy [7,8,15,16] It accounts for an increased operating room time (and costs), and carries a risk of adverse outcome such as biliary lesions [9,10,11]. The objective of the present study was to analyze the feasibility, benefit and risk of performing systematic IOC in a cohort of patients undergoing cholecystectomy for acute gallstone-related disease. The aim of the present study was to evaluate the feasibility, benefit and risk of performing systematic IOC in patients undergoing cholecystectomy for acute gallstone-related disease
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