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Kovács N, Németh D, Földi M, Nagy B, Bunduc S, Hegyi P, Bajor J, Müller KE, Vincze Á, Erőss B, Ábrahám S. Selective intraoperative cholangiography should be considered over routine intraoperative cholangiography during cholecystectomy: a systematic review and meta-analysis. Surg Endosc 2022; 36:7126-7139. [PMID: 35794500 PMCID: PMC9485186 DOI: 10.1007/s00464-022-09267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/09/2022] [Indexed: 11/29/2022]
Abstract
Background Decades of debate surround the use of intraoperative cholangiography (IOC) during cholecystectomy. To the present day, the role of IOC is controversial as regards decreasing the rate of bile duct injury (BDI). We aimed to review and analyse the available literature on the benefits of IOC during cholecystectomy. Methods A systematic literature search was performed until 19 October 2020 in five databases using the following search keys: cholangiogra* and cholecystectomy. The primary outcomes were BDI and retained stone rate. To investigate the differences between the groups (routine IOC vs selective IOC and IOC vs no IOC), we calculated weighted mean differences (WMD) for continuous outcomes and relative risks (RR) for dichotomous outcomes, with 95% confidence intervals (CI). Results Of the 19,863 articles, 38 were selected and 32 were included in the quantitative synthesis. Routine IOC showed no superiority compared to selective IOC in decreasing BDI (RR = 0.91, 95% CI 0.66; 1.24). Comparing IOC and no IOC, no statistically significant differences were found in the case of BDI, retained stone rate, readmission rate, and length of hospital stay. We found an increased risk of conversion rate to open surgery in the no IOC group (RR = 0.64, CI 0.51; 0.78). The operation time was significantly longer in the IOC group compared to the no IOC group (WMD = 11.25 min, 95% CI 6.57; 15.93). Conclusion Our findings suggest that IOC may not be indicated in every case, however, the evidence is very uncertain. Further good quality research is required to address this question. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09267-x.
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Affiliation(s)
- Norbert Kovács
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.,Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Dávid Németh
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary.,Institute of Bioanalysis, University of Pécs Medical School, Pécs, Hungary
| | - Mária Földi
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.,Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Bernadette Nagy
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Stefania Bunduc
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary.,Gastroenterology, Hepatology and Liver Transplant Department, Fundeni Clinical Institute, Bucharest, Romania.,Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs Medical School, Pécs, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Bajor
- Division of Gastroenterology, First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Katalin Eszter Müller
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary.,Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs Medical School, Pécs, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szabolcs Ábrahám
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Centre, University of Szeged, Semmelweis u. 8, 6720, Szeged, Hungary.
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