Routine on-table cholangiography during cholecystectomy: a systematic review

Area of Science:

• Surgical Innovation
• Gastroenterology
• Hepatobiliary Surgery

Background:

• Cholecystectomy is a common surgical procedure.
• On-table cholangiography (OTC) is used to detect common bile duct (CBD) stones during surgery.
• The routine use of OTC (R-OTC) versus no OTC (N-OTC) is debated.

Purpose of the Study:

• To systematically analyze randomized trials comparing R-OTC and N-OTC efficacy in cholecystectomy patients.
• To evaluate the impact of R-OTC on CBD injury, operative time, complications, and stone detection.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials.
• Included trials compared R-OTC versus N-OTC in patients undergoing cholecystectomy.
• Fixed-effects model used due to lack of significant heterogeneity.

Main Results:

• Four trials (860 patients) were analyzed.
• N-OTC did not increase CBD injury risk and was associated with shorter operative time and fewer complications.
• R-OTC improved peri-operative CBD stone detection and reduced readmissions for retained stones.

Conclusions:

• N-OTC is comparable to R-OTC regarding CBD injury risk during cholecystectomy.
• N-OTC offers advantages in operative time and peri-operative complications.
• R-OTC is beneficial for CBD stone detection, reducing readmissions; N-OTC may be suitable for select patients pending further validation.