Southwestern Surgical CongressRoutine intraoperative cholangiography is unnecessary in patients with mild gallstone pancreatitis and normalizing bilirubin levels

- The use of intraoperative cholangiography (IOC) in mild gallstone pancreatitis with normalizing bilirubin levels remains hotly debated.
- The authors compared the experiences of 2 university-affiliated institutions with vastly different protocols (routine IOC vs restricted IOC) for the management of this process.
- A retrospective analysis of 520 patients comparing outcomes that included the length of stay, operative duration, number of postoperative interventions, and rates of readmission was performed.
- Routine IOC does not result in decreased rate of readmission for recurrent biliary pancreatitis while instead increasing the operative duration, postoperative and total length of stay, and the number of postoperative interventions used.

BackgroundThe benefit of intraoperative cholangiography (IOC) is controversial in patients with gallstone pancreatitis whose bilirubin levels are normalizing. IOC with subsequent endoscopic retrograde cholangiopancreatography may lengthen duration of surgery and length of stay, whereas failure to clear the common bile duct may result in recurrent pancreatitis.MethodsWe performed a 6-year retrospective cohort analysis of consecutive adult patients with mild gallstone pancreatitis undergoing same-admission cholecystectomy at 2 university-affiliated medical centers. Institution A routinely performed IOC, whereas institution B did not. The primary outcome was readmission within 30 days for recurrent pancreatitis.ResultsOf 520 patients evaluated, 246 (47%) were managed at institution A (routine IOC) and 274 (53%) were managed at institution B (restricted IOC). Patients at institution B had a shorter duration of surgery (1.0 vs 1.6 hours, P < .001), shorter length of stay (4 vs 5 days, P < .001), and fewer postoperative endoscopic retrograde cholangiopancreatographies performed (1.8% vs 21%, P < .001), without a difference in readmissions (1.5% vs 0%, P = .12).ConclusionsRoutine IOC is not necessary in the setting of mild gallstone pancreatitis with normalizing bilirubin values.