La cholangiographie peropératoire systématique réduit-elle le risque de plaie biliaire au cours des cholécystectomies par laparoscopie ? Approche factuelle

The role of routine intraoperative cholangiography (IOC) during cholecystectomy is still controversial. The aim of this evidence-based review is to assess this role of prevention or detection of common bile duct injuries during cholecystectomy. The relative rarity of this incident make randomized controlled trials or meta-analyses including less than 12,000 patients not appropriate to answer the question. In this way, only six comparative studies were included in this review. Results of these studies were conflicting, half of them showing that routine IOC can be beneficial, and the other half no effect. American and Swedish studies including the largest number of patients have nevertheless suggested that, even if it is not the panacea, routine IOC could prevent serious biliary incidents (almost 1 out of 500 cholecystectomies). Finally, in the setting of risk management, one should highlight the importance of teaching the young (and the less young) surgeon how to interpret intraoperative cholangiograms.