A meta-analysis of the use of intraoperative cholangiography; time to revisit our approach to cholecystectomy?

Eoin Donnellan; Jonathan Coulter; Cherian Mathew; Michelle Choynowski; Louise Flanagan; Magda Bucholc; Alison Johnston; Michael Sugrue

doi:10.1016/j.sopen.2020.07.004

A meta-analysis of the use of intraoperative cholangiography; time to revisit our approach to cholecystectomy?

Surg Open Sci. 2020 Aug 15:3:8-15. doi: 10.1016/j.sopen.2020.07.004. eCollection 2021 Jan.

Authors

Eoin Donnellan^{1

2}, Jonathan Coulter^{1

3}, Cherian Mathew^{1

2}, Michelle Choynowski¹, Louise Flanagan³, Magda Bucholc⁴, Alison Johnston¹, Michael Sugrue^{1

3}

Affiliations

¹ Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, County Donegal, Ireland.
² School of Medicine, National University of Ireland, Galway, Ireland.
³ EU INTERREG Emergency Surgery Outcome Advancement Project, Centre for Personalised Medicine, Letterkenny, Ireland.
⁴ Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Londonderry, Northern Ireland.

Abstract

Background: Despite some evidence of improved survival with intraoperative cholangiography during cholecystectomy, debate has raged about its benefit, in part because of its questionable benefit, time, and resources required to complete.

Methods: An International Prospective Register of Systematic Reviews-registered (ID CRD42018102154) meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Scopus, Web of Science, and Cochrane library from 2003 to 2018 was undertaken including search strategy "intraoperative AND cholangiogra* AND cholecystectomy." Articles scoring ≥ 16 for comparative and ≥ 10 for noncomparative using the Methodological Index for Non-Randomized Studies criteria were included. A dichotomous random effects meta-analysis using the Mantel-Haenszel method performed on Review Manager Version 5.3 was carried out.

Results: Of 2,059 articles reviewed, 62 met criteria for final analysis. The mean rate of intraoperative cholangiography was 38.8% (range 1.6%-96.4%).There was greater detection of bile duct stones during cholecystectomy with routine intraoperative cholangiography compared with selective intraoperative cholangiography (odds ratio = 3.28, confidence interval = 2.80-3.86, P value < .001). While bile duct injury during cholecystectomy was less with intraoperative cholangiography (0.39%) than without intraoperative cholangiography (0.43%), it was not statistically significant (odds ratio = 0.88, confidence interval = 0.65-1.19, P value = .41). Readmission following cholecystectomy with intraoperative cholangiography was 3.0% compared to 3.5% without intraoperative cholangiography (odds ratio = 0.91, confidence interval = 0.78-1.06, P value = .23).

Conclusion: The use of intraoperative cholangiography still has its place in cholecystectomy based on the detection of choledocholithiasis and the potential reduction of unfavorable outcomes associated with common bile duct stones. This meta-analysis, the first to review intraoperative cholangiography use, identified a marked variation in cholangiography use. Retrospective studies limit the ability to critically define association between intraoperative cholangiography use and bile duct injury.

Publication types

Review