|
|
|
| Intraoperative cholangiography 2020: Quo vadis? A systematic review of the literature |
| Konstantinos Georgiou a , Gabriel Sandblom b , Nicholas Alexakis a , Lars Enochsson c , ∗ |
a First Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens 10679, Greece
b Department of Clinical Science and Education, Department of Surgery, Karolinska Institutet, Södersjukhuset, Stockholm 17177, SE, Sweden
c Department of Surgical and Perioperative Sciences, Surgery, UmeaUniversity, Umea 90187, SE, Sweden
∗ Corresponding author.
E-mail address: lars.enochsson@umu.se (L. Enochsson). |
|
|
|
Abstract Background: There are few randomized controlled trials with sufficient statistical power to assess the effectiveness of intraoperative cholangiography (IOC) in the detection and treatment of common bile duct injury (BDI) or retained stones during cholecystectomy. The best evidence so far regarding IOC and re- duced morbidity related to BDI and retained common bile duct stones was derived from large population-based cohort studies. Population-based studies also have the advantage of reflecting the outcome of the procedure as it is practiced in the community at large. However, the outcomes of these population-based studies are conflicting.
Data sources: A systematic literature search was conducted in 2020 to search for articles that contained the terms “bile duct injury”, “critical view of safety”, “bile duct imaging”or “retained stones”in combi- nation with IOC. All identified references were screened to select population-based studies and observa- tional studies from large centers where socioeconomic or geographical selections were assumed not to cause selection bias.
Results: The search revealed 273 references. A total of 30 articles fulfilled the criteria for a large observational study with minimal risk for selection bias. The majority suggested that IOC reduces morbidity associated with BDI and retained common bile duct stones. In the short term, IOC increases the cost of surgery. However, this is offset by reduced costs in the long run since BDI or retained stones detected during surgery are managed immediately.
Conclusions: IOC reduces morbidity associated with BDI and retained common bile duct stones. The reports reviewed are derived from large, unselected populations, thereby providing a high external validity. However, more studies on routine and selective IOC with well-defined outcome measures and sufficient statistical power are needed.
|
|
|
|
|
|
|
|
|
2022, Vol. 21 
