• Björn Törnqvist, Cecilia Strömberg, Gunnar Persson, and Magnus Nilsson.
• Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden. bjorn.tornqvist@karolinska.se
• BMJ. 2012 Jan 1;345:e6457.

ObjectivesTo determine whether the routine use of intraoperative cholangiography can improve survival from complications related to bile duct injuries.DesignPopulation based cohort study.SettingProspectively collected data from the Swedish national registry of gallstone surgery and endoscopic retrograde cholangiopancreatography, GallRiks. Multivariate analysis done by Cox regression.PopulationAll cholecystectomies recorded in GallRiks between 1 May 2005 and 31 December 2010.Main Outcome MeasuresEvidence of bile duct injury, rate of intended use of intraoperative cholangiography, and rate of survival after cholecytectomy.ResultsDuring the study, 51,041 cholecystectomies were registered in GallRiks and 747 (1.5%) iatrogenic bile duct injuries identified. Patients with bile duct injuries had an impaired survival compared with those without injury (mortality at one year 3.9% v 1.1%). Kaplan-Meier analysis showed that early detection of a bile duct injury, during the primary operation, improved survival. The intention to use intraoperative cholangiography reduced the risk of death after cholecystectomy by 62% (hazard ratio 0.38 (95% confidence interval 0.31 to 0.46)).ConclusionsThe high incidence of bile duct injury recorded is probably from GallRiks' ability to detect the entire range of injury severities, from minor ductal lesions to complete transections of major ducts. Patients with bile duct injury during cholecystectomy had impaired survival, and early detection of the injury improved survival. The intention to perform an intraoperative cholangiography reduced the risk of death after cholecystectomy.

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