Contribution of intraoperative cholangiography to incidence and outcome of common bile duct injuries during laparoscopic cholecystectomy

Abstract

The use of IOC can avoid severe types of CBD injuries during LC, increase the recognition at the time operation, and influence the success of repair and outcome of the patients.

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

“…Archer et al [13] reported that routine use of IOC increased detection of BDI from 45 % to 85 %, which is similar to the increased detection described by Ludwig et al [9] from 45 % to 90 %. Intraoperative detection of a ductal injury should decrease the technical difficulty of a repair, because there is no infection, inflammation, or fibrosis in the operating field compared with a delayed repair.…”

“…Performing IOC means an increased operative time, which has been reported in the literature as 8, 10, 16, and 20 min respectively [9,58,67,68]. However, studies have indicated that despite the increased time in operative procedure and materials, routine IOC is cost-effective by reducing the severity of bile duct injury and the cost of treatment of patients with retained stones who did not receive IOC [56,61,69].…”

“…The most common major complication is bile duct injury (BDI), with published rates as high as 1.4 %, although the literature more commonly reports incidence as 0.15-0.6 %, approximately one per 200 procedures [2][3][4][5][6][7][8][9]. In contrast, the incidence of BDI after open cholecystectomy (OC) is reported as 0.1-0.3 %, an equivalent nearer to one per 500 cases [10,11].…”

“…The poor outcome after BDI often is determined by the severity and level of the injury during LC. Ludwig et al found that the most common lesions are type C and D according to the Neuhaus classification, injuries that often can require a biliodigestive anastomosis, which confers significant morbidity and mortality [9]. Lillemoe et al [46] also compared BDIs sustained during LC versus OC and found that the injuries associated with LC tended to be more complex, with more than 60 % classified as Bismuth 3 or higher compared with only 40 % of this severity as a result of OC.…”

Prevention of Common Bile Duct Injuries in Laparoscopic Cholecystectomy

“…A metaanalysis of 40 case series detailing 327,523 LCs and 405 major injuries was performed in 2002. 23 Rate of injury was halved in the routine IOC group (0.21%) as compared with the selective group (0.43%). In addition, in the selective group, only 21.7% of CBD injuries were detected intraoperatively.…”