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Intraoperative detection of aberrant biliary anatomy via intraoperative cholangiography during laparoscopic cholecystectomy.
ANZ J Surg 2019; 89(7-8):889-894AJ

Abstract

BACKGROUND

Laparoscopic cholecystectomy (LC) is the standard of treatment for symptomatic cholelithiasis. Although intraoperative cholangiography (IOC) is widely used as an adjunct to LC, there is still no worldwide consensus on the value of its routine use. Anatomical studies have shown that variations of the biliary tree are present in approximately 35% of patients with variations in right hepatic second-order ducts being especially common (15-20%). Approximately, 70-80% of all iatrogenic bile duct injuries are a consequence of misidentification of biliary anatomy. The purpose of this study was to assess the adequacy of and the reporting of IOCs during LC.

METHODS

IOCs obtained from 300 consecutive LCs between July 2014 and July 2016 were analysed retrospectively by two surgical trainees and confirmed by a radiologist. Biliary tree anatomy was classified from IOC films as described by Couinaud (1957) and correlated with documented findings. The accuracy of intraoperative reporting was assessed. Biliary anatomy was correlated to clinical outcome.

RESULTS

A total of 95% of IOCs adequately demonstrated biliary anatomy. Aberrant right sectoral ducts were identified in 15.2% of the complete IOCs, and 2.6% demonstrated left sectoral or confluence anomalies. Only 20.4% of these were reported intraoperatively. Bile leaks occurred in two patients who had IOCs (0.73%) and two who did not (7.4%).

CONCLUSION

Surgeons generally demonstrate biliary anatomy well on IOC but reporting of sectoral duct variation can be improved. Further research is needed to determine whether anatomical variation is related to ductal injury.

Authors+Show Affiliations

Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia.Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia. School of Medicine, Western Sydney University, Penrith, New South Wales, Australia.Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia.Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia. School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.Department of Radiology, Westmead Hospital, Westmead, New South Wales, Australia.Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia. School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia. School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia. School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia. School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia. School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.Upper Gastrointestinal/HPB Surgery, Westmead Hospital, Westmead, New South Wales, Australia. School of Medicine, The University of Sydney, Sydney, New South Wales, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31083792

Citation

Chehade, Marthe, et al. "Intraoperative Detection of Aberrant Biliary Anatomy Via Intraoperative Cholangiography During Laparoscopic Cholecystectomy." ANZ Journal of Surgery, vol. 89, no. 7-8, 2019, pp. 889-894.
Chehade M, Kakala B, Sinclair JL, et al. Intraoperative detection of aberrant biliary anatomy via intraoperative cholangiography during laparoscopic cholecystectomy. ANZ J Surg. 2019;89(7-8):889-894.
Chehade, M., Kakala, B., Sinclair, J. L., Pang, T., Al Asady, R., Richardson, A., ... Hollands, M. (2019). Intraoperative detection of aberrant biliary anatomy via intraoperative cholangiography during laparoscopic cholecystectomy. ANZ Journal of Surgery, 89(7-8), pp. 889-894. doi:10.1111/ans.15267.
Chehade M, et al. Intraoperative Detection of Aberrant Biliary Anatomy Via Intraoperative Cholangiography During Laparoscopic Cholecystectomy. ANZ J Surg. 2019;89(7-8):889-894. PubMed PMID: 31083792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraoperative detection of aberrant biliary anatomy via intraoperative cholangiography during laparoscopic cholecystectomy. AU - Chehade,Marthe, AU - Kakala,Benedict, AU - Sinclair,Jane-Louise, AU - Pang,Tony, AU - Al Asady,Rafid, AU - Richardson,Arthur, AU - Pleass,Henry, AU - Lam,Vincent, AU - Johnston,Emma, AU - Yuen,Lawrence, AU - Hollands,Michael, Y1 - 2019/05/13/ PY - 2019/01/21/received PY - 2019/04/04/revised PY - 2019/04/05/accepted PY - 2019/5/15/pubmed PY - 2019/5/15/medline PY - 2019/5/15/entrez KW - anatomy KW - biliary KW - cholangiogram KW - cholecystectomy SP - 889 EP - 894 JF - ANZ journal of surgery JO - ANZ J Surg VL - 89 IS - 7-8 N2 - BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard of treatment for symptomatic cholelithiasis. Although intraoperative cholangiography (IOC) is widely used as an adjunct to LC, there is still no worldwide consensus on the value of its routine use. Anatomical studies have shown that variations of the biliary tree are present in approximately 35% of patients with variations in right hepatic second-order ducts being especially common (15-20%). Approximately, 70-80% of all iatrogenic bile duct injuries are a consequence of misidentification of biliary anatomy. The purpose of this study was to assess the adequacy of and the reporting of IOCs during LC. METHODS: IOCs obtained from 300 consecutive LCs between July 2014 and July 2016 were analysed retrospectively by two surgical trainees and confirmed by a radiologist. Biliary tree anatomy was classified from IOC films as described by Couinaud (1957) and correlated with documented findings. The accuracy of intraoperative reporting was assessed. Biliary anatomy was correlated to clinical outcome. RESULTS: A total of 95% of IOCs adequately demonstrated biliary anatomy. Aberrant right sectoral ducts were identified in 15.2% of the complete IOCs, and 2.6% demonstrated left sectoral or confluence anomalies. Only 20.4% of these were reported intraoperatively. Bile leaks occurred in two patients who had IOCs (0.73%) and two who did not (7.4%). CONCLUSION: Surgeons generally demonstrate biliary anatomy well on IOC but reporting of sectoral duct variation can be improved. Further research is needed to determine whether anatomical variation is related to ductal injury. SN - 1445-2197 UR - https://www.unboundmedicine.com/medline/citation/31083792/Intraoperative_detection_of_aberrant_biliary_anatomy_via_intraoperative_cholangiography_during_laparoscopic_cholecystectomy L2 - https://doi.org/10.1111/ans.15267 DB - PRIME DP - Unbound Medicine ER -