Featured Research

from universities, journals, and other organizations

X-ray of ducts during gallbladder surgery not linked with reduction in risk of common duct injury

Date:
August 28, 2013
Source:
American Medical Association (AMA)
Summary:
In an analysis of a procedure used to help prevent common duct injury during gallbladder removal surgery, use of intraoperative cholangiography (radiologic examination of the ducts during gallbladder surgery) was not associated with a reduced risk of common duct injury.

In an analysis of a procedure used to help prevent common duct injury during gallbladder removal surgery, use of intraoperative cholangiography (radiologic examination of the ducts during gallbladder surgery) was not associated with a reduced risk of common duct injury, according to a study in the August 28 issue of JAMA.

"Biliary anatomy misidentification during cholecystectomy [gallbladder removal] can result in injury to the common hepatic duct or common bile duct. Common duct injuries cause significant short- and long-term morbidity including major operations, multiple hospitalizations, and biliary strictures. Elimination of common duct injury is desirable, but it has remained stubbornly present with rates ranging from 0.3 percent to 0.5 percent," according to background information in the article. "When routinely used, intra-operative cholangiography is thought to prevent common duct injury. However, controversy exists regarding the effectiveness of routine use in the prevention of common duct injury."

Kristin M. Sheffield, Ph.D., and Taylor S. Riall, M.D., Ph.D., of the University of Texas Medical Branch, Galveston, and colleagues investigated the association between intraoperative cholangiography use during cholecystectomy and common duct injury, using instrumental variable analysis, an effective way to overcome unmeasured confounding (i.e., factors influencing outcomes not found in the database). The researchers identified Medicare beneficiaries from Texas Medicare claims data who underwent inpatient or outpatient cholecystectomy for conditions including biliary colic or biliary dyskinesia, acute cholecystitis, or chronic cholecystitis. Percentage of intraoperative cholangiography use at the hospital and by surgeon were the instrumental variables. Patients with claims for common duct repair operations within 1 year of cholecystectomy were considered as having major common duct injury.

A total of 92,932 Medicare beneficiaries 66 years or older underwent cholecystectomy at 307 hospitals in Texas from 2001 through 2009. There were 37,533 cholecystectomies with intraoperative cholangiography (40.4 percent) and 55,399 without (59.6 percent). Common duct injury occurred in 280 patients (0.30 percent). There were 201 common duct injuries (0.36 percent) in patients undergoing cholecystectomy without intraoperative cholangiography and 79 injuries (0.21 percent) for those having an intraoperative cholangiography.

"In a logistic regression model controlling for patient, surgeon, and hospital characteristics, the odds of common duct injury for cholecystectomies performed without intraoperative cholangiography were increased compared with those performed with it. When confounding was controlled with instrumental variable analysis, the association between cholecystectomy performed without intraoperative cholangiography and duct injury was no longer significant," the authors write.

"Significant controversy exists regarding the role of intraoperative cholangiography in the prevention of common duct injury during cholecystectomy. Previous population-based studies using data from Medicare claims, hospital discharge records, and national inpatient registries report nearly 2-fold higher rates of injury in cholecystectomies performed without intraoperative cholangiography. In the present study using Texas Medicare claims data, the association between intraoperative cholangiography and common duct injury was highly sensitive to the analytic method used."

"Failure to account for potentially confounding variables not routinely captured in administrative databases has a major effect on the interpretation of the findings. Intraoperative cholangiography was not associated with significant reduction in common duct injury using instrumental variable analysis. Instrumental variable analysis balances unmeasured confounding variables to better align risk factors in comparator groups. With better control for unmeasured confounding variables, intraoperative cholangiography was no longer associated with common duct injury. Based on these results, routine intraoperative cholangiography should not be advocated as means for preventing common duct injury," the researchers conclude.

Editorial: Laparoscopic Cholecystectomy, Intraoperative Cholangiograms, and Common Duct Injuries

In an accompanying editorial, Karl Y. Bilimoria, M.D., M.S., of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues comment on the findings of this study.

"While the report by Sheffield et al does not definitively close the door on routine intraoperative cholangiography use, the authors have again directed attention to an important clinical debate by using a new approach to revisit the outcomes of intraoperative cholangiography using observational data. While the true effect of intraoperative cholangiography on the safety of laparoscopic cholecystectomy remains controversial, this study will undoubtedly reinvigorate the discussion."


Story Source:

The above story is based on materials provided by American Medical Association (AMA). Note: Materials may be edited for content and length.


Cite This Page:

American Medical Association (AMA). "X-ray of ducts during gallbladder surgery not linked with reduction in risk of common duct injury." ScienceDaily. ScienceDaily, 28 August 2013. <www.sciencedaily.com/releases/2013/08/130827203935.htm>.
American Medical Association (AMA). (2013, August 28). X-ray of ducts during gallbladder surgery not linked with reduction in risk of common duct injury. ScienceDaily. Retrieved July 31, 2014 from www.sciencedaily.com/releases/2013/08/130827203935.htm
American Medical Association (AMA). "X-ray of ducts during gallbladder surgery not linked with reduction in risk of common duct injury." ScienceDaily. www.sciencedaily.com/releases/2013/08/130827203935.htm (accessed July 31, 2014).

Share This




More Health & Medicine News

Thursday, July 31, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

House Republicans Vote to Sue Obama Over Healthcare Law

House Republicans Vote to Sue Obama Over Healthcare Law

Reuters - US Online Video (July 31, 2014) The Republican-led House of Representatives votes to sue President Obama, accusing him of overstepping his executive authority in making changes to the Affordable Care Act. Mana Rabiee reports. Video provided by Reuters
Powered by NewsLook.com
Despite Health Questions, E-Cigs Are Beneficial: Study

Despite Health Questions, E-Cigs Are Beneficial: Study

Newsy (July 31, 2014) Citing 81 previous studies, new research out of London suggests the benefits of smoking e-cigarettes instead of regular ones outweighs the risks. Video provided by Newsy
Powered by NewsLook.com
Dangerous Bacteria Kills One in Florida

Dangerous Bacteria Kills One in Florida

AP (July 31, 2014) Sarasota County, Florida health officials have issued a warning against eating raw oysters and exposing open wounds to coastal and inland waters after a dangerous bacteria killed one person and made another sick. (July 31) Video provided by AP
Powered by NewsLook.com
Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins