Intraoperative cholangiography 2020:Quo vadis? A systematic review of the literature

作     者：Konstantinos Georgiou Gabriel Sandblom Nicholas Alexakis Lars Enochsson Konstantinos Georgiou;Gabriel Sandblom;Nicholas Alexakis;Lars Enochsson

作者机构：First Department of Propaedeutic SurgeryHippokration General Hospital of AthensAthens Medical SchoolNational and Kapodistrian University of AthensAthens 10679Greece Department of Clinical Science and EducationDepartment of SurgeryKarolinska InstitutetSödersjukhusetStockholm 17177SESweden Department of Surgical and Perioperative SciencesSurgeryUmeåUniversityUmeå90187SESweden 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2022年第21卷第2期

页      面：145-153页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Cholangiography Cholecystectomy Bile duct stones Bile duct injury Cost 

摘      要：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 reduced morbidity related to BDI and retained common bile duct stones was derived from large populationbased 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 combination with IOC. All identifed references were screened to select population-based studies and observational 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 fulflled 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-defned outcome measures and sufficient statistical power are needed.