834 A 5-Year Retrospective Review of Intra-Operative Cholangiogram Utilisation: Do We Need a Pathway?
S Bezzaa, P Kapsampelis, F Murabit, K Khalifa, I Gerogiannis- Surgery
Abstract
Aim
Current guidance gives no clear consensus on using routine vs selective intra-operative cholangiograms (IOC) during laparoscopic cholecystectomy. This is a controversial area with underuse risking bile-duct injury but overuse wasting theatre time and resources. The study aimed to review our local practice of IOC.
Method
Data was collected from electronic records for all patients undergoing IOCs from 2017 to 2022 at a single District General Hospital (DGH). Statistical analysis was performed using R.
Results
Ninety-six patients underwent IOC (74 elective, 22 emergency). In 64 (67%), use of IOC was decided pre-operatively (planned), 28 (29%) was decided intra-operatively (unplanned), and unclear in four cases (4%). All patients underwent pre-operative imaging. Imaging was negative for choledocholithiasis in 61 cases (64%). Indications for IOCs were abnormal anatomy (18%), deranged biochemistry (32%), abnormal imaging (21%) and confirmed choledocholithiasis (7%). The indication for IOC was unclear in 21 patients (22%). IOCs revealed abnormal findings in 21 cases; 10 required post-operative ERCP/EUS, 6 required further imaging and three were referred to a tertiary centre (for potential bile duct injury). On average, elective cases with unplanned IOC lasted 28 minutes longer (95% CI 4 to 52, p = 0.013) than planned IOC.
Conclusions
Our study revealed that IOC indication was not documented consistently, and unplanned elective IOC cases lasted significantly longer. Therefore, we propose a local pathway to identify, pre-operatively, the patients who need IOC. This will result in safer patient care and less operating time and resources. Furthermore, dedicated IOC lists may help DGHs streamline theatre lists and improve efficiency.