BN SO51 - Complications from operative cholangiogram during emergency laparoscopic cholecystectomy: A retrospective, observational cohort study in a UK single centre

Abstract Background Laparoscopic cholecystectomy (LC) is a common surgical procedure, with >60,000 undertaken annually in the UK. One serious complication of cholecystectomy is bile-duct-injury (BDI), with an incidence of 0.28–1.5%. The use of intraoperative-cholangiogram (OTC) has been shown to aid in earlier diagnosis and treatment of BDI. Although advocated as routine by many, no studies have assessed the morbidity caused by OTC. With newer modalities available, such as indocyanine-green-fluorescent-cholangiography (ICGC) and three-dimensional laparoscopy, it is important to consider each method's risks and benefits, including OTC. We decided to investigate the morbidity caused by OTC with an emphasis on post-OTC acute pancreatitis. Method We conducted a retrospective cohort study of a prospectively collected cohort of patients aged 18 and over who have undergone emergency LC, defined as LC within seven days from admission with acute cholecystitis, over three years in a UK district general hospital. The primary outcome studied was the incidence of complications following OTC, including acute pancreatitis (AP), acute cholangitis, extra-hepatic biliary tree injury and hepatic abscess. The STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) checklist was utilised. We used GraphPad Prism 10.2.3. for statistical analysis. Results 472 cases were analysed. Median age was 54(A), BMI 31(C), ASA grade 2(D), clinical frailty score 2(E), Charlson Comorbidity Index 1(F), Tokyo severity grade 1(K) and female-to-male ratio 0.83(B). 14.31% of cases had pre-op CBD dilatation, 0.42% CBD stones and 6.19% both, with most having ultrasound pre-op (J-I). The median Nassar score was 3(L). 24.57 % of cases had an OTC done, with a median volume of contrast-media used of 11(6;24.5) mls, with 17 cases having CBD stones diagnosed(M-O). Four cases, or 3.44% of the total OTCs, developed acute pancreatitis (P). Conclusion Emergency laparoscopic cholecystectomy with intraoperative cholangiogram may increase the risk of postoperative acute pancreatitis.