Routine on-table cholangiography during cholecystectomy: a systematic review

M S Sajid, C Leaver, Z Haider, T Worthington, N Karanjia, K K Singh, M S Sajid, C Leaver, Z Haider, T Worthington, N Karanjia, K K Singh

Abstract

Introduction: The aim of this review was to systemically analyse trials evaluating the efficacy of routine on-table cholangiography (R-OTC) versus no on-table cholangiography (N-OTC) in patients undergoing cholecystectomy.

Methods: Randomised trials evaluating R-OTC versus N-OTC in patients undergoing cholecystectomy were selected and analysed.

Results: Four trials (1 randomised controlled trial on open cholecystectomy and 3 on laparoscopic cholecystectomy) encompassing 860 patients undergoing cholecystectomy with and without R-OTC were retrieved. There were 427 patients in the R-OTC group and 433 patients in the N-OTC group. There was no significant heterogeneity among trials. Therefore, in the fixed effects model, N-OTC did not increase the risk (p=0.53) of common bile duct (CBD) injury, and it was associated with shorter operative time (p<0.00001) and fewer peri-operative complications (p<0.04). R-OTC was superior in terms of peri-operative CBD stone detection (p<0.006) and it reduced readmission (p<0.03) for retained CBD stones.

Conclusions: N-OTC is associated with shorter operative time and fewer peri-operative complications, and it is comparable to R-OTC in terms of CBD injury risk during cholecystectomy. R-OTC is helpful for peri-operative CBD stone detection and there is therefore reduced readmission for retained CBD stones. The N-OTC approach may be adopted routinely for patients undergoing laparoscopic cholecystectomy providing there are no clinical, biochemical or radiological features suggestive of CBD stones. However, a major multicentre randomised controlled trial is required to validate this conclusion.

Figures

Figure 1
Figure 1
Trial selection methodology
Figure 2
Figure 2
Operative time
Figure 3
Figure 3
Common bile duct stone detection rate
Figure 4
Figure 4
Incidence of common bile duct injury
Figure 5
Figure 5
Peri-operative complications (all trials)
Figure 6
Figure 6
Readmission rate
Figure 7
Figure 7
Peri-operative complications (trials on laparoscopic cholecystectomy only)

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