N-OTC is associated with shorter operative time and fewer peri-operative complications , and it is comparable to R-OTC in terms of CBD injury risk during cholecystectomy .
R-OTC is helpful for peri-operative CBD stone detection and there is therefore reduced readmission for retained CBD stones .
The N-OTC approach may be adopted routinely for patients undergoing laparoscopic cholecystectomy providing there are no clinical , biochemical or radiological features suggestive of CBD stones .
INTRODUCTION The aim of this review was to systemically analyse trials evaluating the efficacy of routine on-table cholangiography ( R-OTC ) versus no on-table cholangiography ( N-OTC ) in patients undergoing cholecystectomy .
Open Cholecystectomy A Contemporary Analysis of 42,474 Patients
Objective This study evaluated , in a large , heterogeneous population , the outcome of  open cholecystectomy  as it is currently practice d. Summary Background and Data Although cholecystectomy has been the gold st and ard of treatment for cholelithiasis for more than 100 years , it has recently been challenged by the introduction of several new modalities including laparoscopic cholecystectomy . Efforts to define the role of these alternative treatments have been hampered by the lack of contemporary data regarding open cholecystectomy . Methods A population -based study was performed examining all open cholecystectomies performed by surgeons in an eastern and western state during a recent 12-month period . Data compiled consisted of a computerized analysis of Uniformed Billing ( UB-82 ) discharge analysis information from all non-Veterans Administration ( VA ) , acute care hospitals in California ( Office of Statewide Planning and Development [ OSHPD ] ) and in Maryl and ( Health Services Cost Review Commission [ HSCRC ] ) between January 1 , 1989 , and December 31 , 1989 . This data base was supplemented with a 5 % r and om sample of Medicare UB-82 data from patients who were discharged between October 1,1988 , and September 30 , 1989 . Patients undergoing cholecystectomy  were identified based on diagnosis-related groups ( DRG-197 and DRG-198 ) , and then classified by Principal Diagnosis and divided into three clinical ly homogeneous subgroups : acute cholecystitis , chronic cholecystitis , and complicated cholecystitis . Results A total of 42,474 patients were analyzed , which represents approximately 8 % of all patients undergoing cholecystectomy in the United States in any recent 12-month period . The overall mortality rate was 0.17 % and the Incidence rate of bile duct injuries was approximately 0.2 % . The mortality rate was 0.03 % in patients younger than 65 years of age and 0.5 % in those older than 65 years of age . Mortality rate , length of hospital stay , and charges were all significantly correlated ( p < 0.001 ) with age , admission status ( elective , urgent , or emergent ) , and disease status . Conclusions These data indicate that open cholecystectomy currently is a very safe , effective treatment for cholelithiasis and is being performed with near zero mortality . The ultimate role of
N-OTC is associated with shorter operative time and fewer peri-operative complications , and it is comparable to R-OTC in terms of CBD injury risk during cholecystectomy .
R-OTC is helpful for peri-operative CBD stone detection and there is therefore reduced readmission for retained CBD stones .
The N-OTC approach may be adopted routinely for patients undergoing laparoscopic cholecystectomy providing there are no clinical , biochemical or radiological features suggestive of CBD stones .
INTRODUCTION The aim of this review was to systemically analyse trials evaluating the efficacy of routine on-table cholangiography ( R-OTC ) versus no on-table cholangiography ( N-OTC ) in patients undergoing cholecystectomy .