Comparison of pre-operative computed tomography cholangiography and intraoperative cholangiography in laparoscopic cholecystectomy: a retrospective analysis

BACKGROUND: The role of intra-operative cholangiography (IOC) in laparoscopic cholecystectomy (LC) is controversial. CT cholangiography (CTC) provides a reliable assessment of biliary anatomy, potentially reducing operating times, open conversion, and complication rates. This study aims to assess the safety and effectiveness of routine pre-operative CTC. METHODS: A single centre retrospective analysis was undertaken of all elective laparoscopic cholecystectomies between 2017 and 2021. Information was obtained from a general surgical database alongside hospital electronic medical records. T-tests and Chi(2) tests were used to assess statistical significance. RESULTS: Of 1079 patients, 129 (12.0%) underwent routine pre-operative CTC, 786 (72.8%) routine IOC, and 161 patients (14.9%) neither modality. Comparing CTC and IOC, the CTC group had higher rates of open conversion (3.1% vs. 0.6%, p 0.009), subtotal cholecystectomies (3.1% vs. 0.8%, p 0.018), and length of stay (1.47 vs. 1.18 nights, p 0.015). Comparing the prior groups together against those utilising neither modality, the latter had reduced operative time (66.29 vs. 72.47, p 0.011), but increased rate of bile leak (1.9% vs. 0.4%, p 0.037) and bile duct injury (1.2% vs. 0.2%, p 0.049). Co-dependence between operative complications was noted in linear regression. CONCLUSION: Biliary imaging with either CTC or IOC is beneficial in reducing bile leak and bile duct injury, and its routine use LC is recommended. However, routine CTC is inferior to routine IOC in preventing conversions to open surgery and subtotal cholecystectomy. Further research may be undertaken to evaluate criteria for a selective CTC protocol.