Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study
Identifieur interne : 000D78 ( Istex/Corpus ); précédent : 000D77; suivant : 000D79Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study
Auteurs : Björn Törnqvist ; Cecilia Strömberg ; Gunnar Persson ; Magnus NilssonSource :
- BMJ : British Medical Journal [ 1756-1833 ] ; 2012.
Abstract
Objectives To determine whether the routine use of intraoperative cholangiography can improve survival from complications related to bile duct injuries. Design Population based cohort study. Setting Prospectively collected data from the Swedish national registry of gallstone surgery and endoscopic retrograde cholangiopancreatography, GallRiks. Multivariate analysis done by Cox regression. Population All cholecystectomies recorded in GallRiks between 1 May 2005 and 31 December 2010. Main outcome measures Evidence of bile duct injury, rate of intended use of intraoperative cholangiography, and rate of survival after cholecytectomy. Results During 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)). Conclusions The 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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DOI: 10.1136/bmj.e6457
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study</title><author><name sortKey="Tornqvist, Bjorn" sort="Tornqvist, Bjorn" uniqKey="Tornqvist B" first="Björn" last="Törnqvist">Björn Törnqvist</name><affiliation><mods:affiliation>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: bjorn.tornqvist@karolinska.se</mods:affiliation></affiliation></author><author><name sortKey="Stromberg, Cecilia" sort="Stromberg, Cecilia" uniqKey="Stromberg C" first="Cecilia" last="Strömberg">Cecilia Strömberg</name><affiliation><mods:affiliation>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Persson, Gunnar" sort="Persson, Gunnar" uniqKey="Persson G" first="Gunnar" last="Persson">Gunnar Persson</name><affiliation><mods:affiliation>Department of Surgery, Ryhov Hospital, Jönköping, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Nilsson, Magnus" sort="Nilsson, Magnus" uniqKey="Nilsson M" first="Magnus" last="Nilsson">Magnus Nilsson</name><affiliation><mods:affiliation>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:85871ACC06848BE7AFD9D2DB4B2D0B5B24DDEA32</idno><date when="2012" year="2012">2012</date><idno type="doi">10.1136/bmj.e6457</idno><idno type="url">https://api.istex.fr/document/85871ACC06848BE7AFD9D2DB4B2D0B5B24DDEA32/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000D78</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study</title><author><name sortKey="Tornqvist, Bjorn" sort="Tornqvist, Bjorn" uniqKey="Tornqvist B" first="Björn" last="Törnqvist">Björn Törnqvist</name><affiliation><mods:affiliation>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: bjorn.tornqvist@karolinska.se</mods:affiliation></affiliation></author><author><name sortKey="Stromberg, Cecilia" sort="Stromberg, Cecilia" uniqKey="Stromberg C" first="Cecilia" last="Strömberg">Cecilia Strömberg</name><affiliation><mods:affiliation>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Persson, Gunnar" sort="Persson, Gunnar" uniqKey="Persson G" first="Gunnar" last="Persson">Gunnar Persson</name><affiliation><mods:affiliation>Department of Surgery, Ryhov Hospital, Jönköping, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Nilsson, Magnus" sort="Nilsson, Magnus" uniqKey="Nilsson M" first="Magnus" last="Nilsson">Magnus Nilsson</name><affiliation><mods:affiliation>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">BMJ : British Medical Journal</title><title level="j" type="abbrev">BMJ</title><idno type="eISSN">1756-1833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2012">2012</date><biblScope unit="volume">345</biblScope></imprint></series><idno type="istex">85871ACC06848BE7AFD9D2DB4B2D0B5B24DDEA32</idno><idno type="DOI">10.1136/bmj.e6457</idno><idno type="href">bmj-345-bmj-e6457.pdf</idno><idno type="ArticleID">torb006060</idno><idno type="local">bmj;345/oct11_1/e6457</idno></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objectives To determine whether the routine use of intraoperative cholangiography can improve survival from complications related to bile duct injuries. Design Population based cohort study. Setting Prospectively collected data from the Swedish national registry of gallstone surgery and endoscopic retrograde cholangiopancreatography, GallRiks. Multivariate analysis done by Cox regression. Population All cholecystectomies recorded in GallRiks between 1 May 2005 and 31 December 2010. Main outcome measures Evidence of bile duct injury, rate of intended use of intraoperative cholangiography, and rate of survival after cholecytectomy. Results During 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)). Conclusions The 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.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>Björn Törnqvist</name><affiliations><json:string>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</json:string><json:string>E-mail: bjorn.tornqvist@karolinska.se</json:string></affiliations></json:item><json:item><name>Cecilia Strömberg</name><affiliations><json:string>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</json:string></affiliations></json:item><json:item><name>Gunnar Persson</name><affiliations><json:string>Department of Surgery, Ryhov Hospital, Jönköping, Sweden</json:string></affiliations></json:item><json:item><name>Magnus Nilsson</name><affiliations><json:string>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</json:string></affiliations></json:item></author><articleId><json:string>torb006060</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Objectives To determine whether the routine use of intraoperative cholangiography can improve survival from complications related to bile duct injuries. Design Population based cohort study. Setting Prospectively collected data from the Swedish national registry of gallstone surgery and endoscopic retrograde cholangiopancreatography, GallRiks. Multivariate analysis done by Cox regression. Population All cholecystectomies recorded in GallRiks between 1 May 2005 and 31 December 2010. Main outcome measures Evidence of bile duct injury, rate of intended use of intraoperative cholangiography, and rate of survival after cholecytectomy. Results During 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)). Conclusions The 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.</abstract><qualityIndicators><score>8.224</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595.276 x 841.89 pts (A4)</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>1641</abstractCharCount><pdfWordCount>5123</pdfWordCount><pdfCharCount>35352</pdfCharCount><pdfPageCount>10</pdfPageCount><abstractWordCount>227</abstractWordCount></qualityIndicators><title>Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study</title><genre><json:string>research-article</json:string></genre><host><volume>345</volume><publisherId><json:string>bmj</json:string></publisherId><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1756-1833</json:string></eissn><title>BMJ : British Medical 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bibliographiques récupérées via GROBID</resp><name resp="ISTEX-API">ISTEX-API (INIST-CNRS)</name></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>British Medical Journal Publishing Group</publisher><availability status="free"><p>Open Access</p></availability><date>2012</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study</title><author xml:id="author-1" corresp="yes"><persName><forename type="first">Björn</forename><surname>Törnqvist</surname></persName><email>bjorn.tornqvist@karolinska.se</email><note type="biography">consultant surgeon</note><affiliation>consultant surgeon</affiliation><affiliation>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</affiliation></author><author xml:id="author-2"><persName><forename type="first">Cecilia</forename><surname>Strömberg</surname></persName><note type="biography">senior consultant surgeon</note><affiliation>senior consultant surgeon</affiliation><affiliation>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</affiliation></author><author xml:id="author-3"><persName><forename type="first">Gunnar</forename><surname>Persson</surname></persName><note type="biography">senior consultant surgeon</note><affiliation>senior consultant surgeon</affiliation><affiliation>Department of Surgery, Ryhov Hospital, Jönköping, Sweden</affiliation></author><author xml:id="author-4"><persName><forename type="first">Magnus</forename><surname>Nilsson</surname></persName><note type="biography">senior consultant surgeon</note><affiliation>senior consultant surgeon</affiliation><affiliation>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</affiliation></author></analytic><monogr><title level="j">BMJ : British Medical Journal</title><title level="j" type="abbrev">BMJ</title><idno type="eISSN">1756-1833</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2012"></date><biblScope unit="volume">345</biblScope></imprint></monogr><idno type="istex">85871ACC06848BE7AFD9D2DB4B2D0B5B24DDEA32</idno><idno type="DOI">10.1136/bmj.e6457</idno><idno type="href">bmj-345-bmj-e6457.pdf</idno><idno type="ArticleID">torb006060</idno><idno type="local">bmj;345/oct11_1/e6457</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2012</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Objectives To determine whether the routine use of intraoperative cholangiography can improve survival from complications related to bile duct injuries. Design Population based cohort study. Setting Prospectively collected data from the Swedish national registry of gallstone surgery and endoscopic retrograde cholangiopancreatography, GallRiks. Multivariate analysis done by Cox regression. Population All cholecystectomies recorded in GallRiks between 1 May 2005 and 31 December 2010. Main outcome measures Evidence of bile duct injury, rate of intended use of intraoperative cholangiography, and rate of survival after cholecytectomy. Results During 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)). Conclusions The 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.</p></abstract></profileDesc><revisionDesc><change when="2012">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-10-4">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/85871ACC06848BE7AFD9D2DB4B2D0B5B24DDEA32/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">bmj</journal-id><journal-id journal-id-type="nlm-ta">BMJ</journal-id><journal-id journal-id-type="publisher-id">bmj</journal-id><journal-title>BMJ : British Medical Journal</journal-title><issn pub-type="epub">1756-1833</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">torb006060</article-id><article-id pub-id-type="doi">10.1136/bmj.e6457</article-id><article-id pub-id-type="other">bmj;345/oct11_1/e6457</article-id><article-id pub-id-type="other">bmj;bmj.e6457</article-id><article-id pub-id-type="other">oct11_1</article-id><article-id pub-id-type="other">bmj.e6457</article-id><article-id pub-id-type="other">bmj.e6457</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Törnqvist</surname><given-names>Björn</given-names></name><role>consultant surgeon</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Strömberg</surname><given-names>Cecilia</given-names></name><role>senior consultant surgeon</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Persson</surname><given-names>Gunnar</given-names></name><role>senior consultant surgeon</role><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Nilsson</surname><given-names>Magnus</given-names></name><role>senior consultant surgeon</role><xref ref-type="aff" rid="aff1">1</xref></contrib><aff id="aff1"><label>1</label>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</aff><aff id="aff2"><label>2</label>Department of Surgery, Ryhov Hospital, Jönköping, Sweden</aff></contrib-group><author-notes><corresp>Correspondence to: B Törnqvist, Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden <email>bjorn.tornqvist@karolinska.se</email></corresp></author-notes><pub-date pub-type="collection"><year>2012</year></pub-date><pub-date pub-type="epub-original"><year>2012</year></pub-date><volume>345</volume><volume-id pub-id-type="other">345</volume-id><volume-id pub-id-type="other">345</volume-id><elocation-id>e6457</elocation-id><history><date date-type="accepted"><day>18</day><month>September</month><year>2012</year></date></history><permissions><copyright-statement>© Törnqvist et al 2012</copyright-statement><copyright-year>2012</copyright-year><copyright-holder>Törnqvist et al</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/2.0/" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/2.0/</ext-link> and <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/2.0/legalcode" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/2.0/legalcode</ext-link>.</p></license></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-345-bmj-e6457.pdf"></self-uri><abstract><p><bold>Objectives</bold> To determine whether the routine use of intraoperative cholangiography can improve survival from complications related to bile duct injuries.</p><p><bold>Design</bold> Population based cohort study.</p><p><bold>Setting</bold> Prospectively collected data from the Swedish national registry of gallstone surgery and endoscopic retrograde cholangiopancreatography, GallRiks. Multivariate analysis done by Cox regression.</p><p><bold>Population</bold> All cholecystectomies recorded in GallRiks between 1 May 2005 and 31 December 2010.</p><p><bold>Main outcome measures</bold> Evidence of bile duct injury, rate of intended use of intraoperative cholangiography, and rate of survival after cholecytectomy. </p><p><bold>Results</bold> During 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% <italic>v</italic> 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)). </p><p><bold>Conclusions</bold> The 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.</p></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Björn</namePart><namePart type="family">Törnqvist</namePart><affiliation>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</affiliation><affiliation>E-mail: bjorn.tornqvist@karolinska.se</affiliation><description>consultant surgeon</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Cecilia</namePart><namePart type="family">Strömberg</namePart><affiliation>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</affiliation><description>senior consultant surgeon</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gunnar</namePart><namePart type="family">Persson</namePart><affiliation>Department of Surgery, Ryhov Hospital, Jönköping, Sweden</affiliation><description>senior consultant surgeon</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Magnus</namePart><namePart type="family">Nilsson</namePart><affiliation>Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden</affiliation><description>senior consultant surgeon</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>British Medical Journal Publishing Group</publisher><dateIssued encoding="w3cdtf">2012</dateIssued><copyrightDate encoding="w3cdtf">2012</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Objectives To determine whether the routine use of intraoperative cholangiography can improve survival from complications related to bile duct injuries. Design Population based cohort study. Setting Prospectively collected data from the Swedish national registry of gallstone surgery and endoscopic retrograde cholangiopancreatography, GallRiks. Multivariate analysis done by Cox regression. Population All cholecystectomies recorded in GallRiks between 1 May 2005 and 31 December 2010. Main outcome measures Evidence of bile duct injury, rate of intended use of intraoperative cholangiography, and rate of survival after cholecytectomy. Results During 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)). Conclusions The 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.</abstract><relatedItem type="host"><titleInfo><title>BMJ : British Medical Journal</title></titleInfo><titleInfo type="abbreviated"><title>BMJ</title></titleInfo><genre type="journal">journal</genre><identifier type="eISSN">1756-1833</identifier><identifier type="PublisherID">bmj</identifier><identifier type="PublisherID-hwp">bmj</identifier><identifier type="PublisherID-nlm-ta">BMJ</identifier><part><date>2012</date><detail type="volume"><caption>vol.</caption><number>345</number></detail></part></relatedItem><identifier type="istex">85871ACC06848BE7AFD9D2DB4B2D0B5B24DDEA32</identifier><identifier type="DOI">10.1136/bmj.e6457</identifier><identifier type="href">bmj-345-bmj-e6457.pdf</identifier><identifier type="ArticleID">torb006060</identifier><identifier type="local">bmj;345/oct11_1/e6457</identifier><accessCondition type="use and reproduction" contentType="open-access">This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.</accessCondition><recordInfo><recordContentSource>BMJ</recordContentSource><recordOrigin>Törnqvist et al</recordOrigin></recordInfo></mods></metadata><annexes><json:item><original>true</original><mimetype>image/jpeg</mimetype><extension>jpeg</extension><uri>https://api.istex.fr/document/85871ACC06848BE7AFD9D2DB4B2D0B5B24DDEA32/annexes/jpeg</uri></json:item></annexes><enrichments><json:item><type>refBibs</type><uri>https://api.istex.fr/document/85871ACC06848BE7AFD9D2DB4B2D0B5B24DDEA32/enrichments/refBibs</uri></json:item></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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