SSAT - The Value of Cholangiography in Elective Cholecystectomy for Patients With Normal Preoperative Liver Function Tests

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The Value of Cholangiography in Elective Cholecystectomy for Patients With Normal Preoperative Liver Function Tests
Jessica L. Burgers^*, Eric Tsung, John O. Elliott, Andrei Radulescu, Edward Dominguez
Medical Education, General Surgery, Riverside Methodist Hospital, Columbus, OH

Background: The rationale for performing intraoperative cholangiography (IOC) during elective laparoscopic cholecystectomy (LC) has undergone several revisions since it was first introduced and its routine use remains a matter of debate. The aim of the current retrospective single institution study was to determine the value of performing routine IOC in patients scheduled for elective LC with normal liver function tests.
Methods: An IRB approved retrospective cohort study was conducted of patients who underwent routine LC with IOC from 2011-2014. Patients were excluded if they had abnormal liver studies, a known premorbid condition of hepatobiliary malignancy or stricture. Univariate analyses examined demographic, comorbidities and clinical status differences between patients with positive test versus a negative IOC.
Results: Of the 695 patient included, 35 patients had a positive IOC, making the rate of incidental choledocholithiasis 5.0% (95%CI: 3.6-6.9). In the multivariate logistic model, preoperative imaging demonstrating sludge was predictive of a higher risk of a positive cholangiogram (OR 2.74, 95%CI: 1.21-6.19). Age was also associated with a positive test (OR 1.03, 95%CI: 1.00-1.07) after controlling for comorbidities and history of prior choledocholithiasis, pancreatitis or cholecystitis. More specifically, patients over the age of 55 has three times the risk of having incidental choledocholithiasis compared to those under the age of 55 (OR 3.00, 95%CI: 1.20-7.53).
Conclusions: Choledocholithiasis was demonstrated on 5% of routine IOC in patients with normal preoperative liver function tests. This indicates marginal benefit in performing cholangiography routinely. However, by multivariate analysis, age and sludge described on imaging were determined to be predictive of a positive IOC. This suggests a potential benefit of identifying choledocholithiasis by cholangiography in patients over the age of 55 or with findings of sludge on preoperative radiographic studies.

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