Selective intraoperative cholangiography and risk of bile duct injury during cholecystectomy

Background: Whether intraoperative cholangiography can prevent iatrogenic bile duct injury during cholecystectomy remains controversial. Methods: Data from the national Swedish Registry for Gallstone Surgery, GallRiks (May 2005 to December 2010), were analysed for evidence of iatrogenic bile duct injury during cholecystectomy. Patient- and procedure-related risk factors for bile duct injury with a focus on the rate of intended intraoperative cholangiography were analysed using multivariable logistic regression. Results: A total of 51041 cholecystectomies and 747 bile duct injuries (15 per cent) were identified; 9008 patients (176 per cent) were diagnosed with acute cholecystitis. No preventive effect of intraoperative cholangiography was seen in uncomplicated gallstone disease (odds ratio (OR) 097, 95 per cent c.i. 074 to 125). Operating in the presence (OR 123, 103 to 147) or a history (OR 134, 110 to 164) of acute cholecystitis, and open surgery (OR 156, 126 to 194), were identified as significant risk factors for bile duct injury. The intention to perform intraoperative cholangiography was associated with a reduced risk of bile duct injury in patients with concurrent (OR 044, 030 to 063) or a history of (OR 059, 035 to 100) acute cholecystitis. Conclusion: Any proposed protective effect of intraoperative cholangiography was restricted to patients with (or a history of) acute cholecystitis.