Selective intraoperative cholangiography should be considered over routine intraoperative cholangiography during cholecystectomy: a systematic review and meta-analysis,Surgical Endoscopy

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Selective intraoperative cholangiography should be considered over routine intraoperative cholangiography during cholecystectomy: a systematic review and meta-analysis
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2022-07-07 , DOI: 10.1007/s00464-022-09267-x
Norbert Kovács _{1,

2} , Dávid Németh _{2,

3} , Mária Földi _{1,

2} , Bernadette Nagy ₂ , Stefania Bunduc _{2,

4,

5} , Péter Hegyi _{6,

7,

8} , Judit Bajor ₉ , Katalin Eszter Müller _{2,

10} , Áron Vincze ₉ , Bálint Erőss _{2,

6,

7} , Szabolcs Ábrahám ₁₁

Affiliation

Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.
Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary.
Institute of Bioanalysis, 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.
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.
Division of Gastroenterology, First Department of Medicine, University of Pécs Medical School, Pécs, Hungary.
Heim Pál National Institute of Pediatrics, Budapest, Hungary.
Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Centre, University of Szeged, Semmelweis u. 8, 6720, Szeged, Hungary.

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.

中文翻译：

胆囊切除术期间应考虑选择性术中胆管造影而不是常规术中胆管造影：系统评价和荟萃分析

背景

围绕胆囊切除术期间术中胆管造影 (IOC) 的使用存在数十年的争论。迄今为止，IOC 在降低胆管损伤 (BDI) 率方面的作用仍存在争议。我们的目的是回顾和分析关于胆囊切除术中 IOC 益处的现有文献。

方法

截至 2020 年 10 月 19 日，我们使用以下检索键在五个数据库中进行了系统文献检索：胆管造影* 和胆囊切除术。主要结果是 BDI 和结石残留率。为了研究各组之间的差异（常规 IOC 与选择性 IOC 以及 IOC 与无 IOC），我们计算了连续结果的加权平均差 (WMD) 和二分结果的相对风险 (RR)，置信区间 (CI) 为 95%。

结果

19863篇文章中，入选38篇，纳入定量综合32篇。与选择性 IOC 相比，常规 IOC 在降低 BDI 方面并无优势（RR = 0.91，95% CI 0.66；1.24）。比较IOC和无IOC，BDI情况、结石残留率、再入院率和住院时间无统计学差异。我们发现无 IOC 组中转开放手术的风险增加（RR = 0.64，CI 0.51；0.78）。与无 IOC 组相比，IOC 组的手术时间明显更长（WMD = 11.25 分钟，95% CI 6.57；15.93）。