Surgical endoscopy · 2026
Bile duct injury versus choledocholithiasis: does one outweigh the other in the decision to use intraoperative cholangiogram during laparoscopic cholecystectomy? A model-based economic analysis.
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Smith Savannah R, Cheney Sarah M, Sarmiento Juan M
Аннотация
BACKGROUND: Routine intraoperative cholangiogram (IOC) remains controversial. Current literature evaluating routine (rIOC) versus selective (sIOC) during laparoscopic cholecystectomy (LC) often overlooks the impact of bile duct injuries (BDIs) and choledocholithiasis.
METHODS: Decision analysis models evaluated costs and quality-adjusted life years (QALYs) of rIOC versus sIOC during LC. Models were based on 0.36 and 0.53% BDI detection in rIOC and sIOC, and 11.8% and 3.9% choledocholithiasis, respectively. Sensitivity analysis assessed model robustness to data input changes.
RESULTS: sIOC was associated with $18,600 and 0.90 QALYs, while rIOC increased costs by $1,300 and reduced QALYs, consistent in 93% of probabilistic sensitivity analyses. In choledocholithiasis with high likelihood of persistence, rIOC was preferred in 88% of iterations.
DISCUSSION: rIOC increases costs without improving QALY when considering both choledocholithiasis and BDI. rIOC was preferred in high-risk choledocholithiasis, implying that judicious intraoperative management of choledocholithiasis is prudent in the decision to utilize IOC.
METHODS: Decision analysis models evaluated costs and quality-adjusted life years (QALYs) of rIOC versus sIOC during LC. Models were based on 0.36 and 0.53% BDI detection in rIOC and sIOC, and 11.8% and 3.9% choledocholithiasis, respectively. Sensitivity analysis assessed model robustness to data input changes.
RESULTS: sIOC was associated with $18,600 and 0.90 QALYs, while rIOC increased costs by $1,300 and reduced QALYs, consistent in 93% of probabilistic sensitivity analyses. In choledocholithiasis with high likelihood of persistence, rIOC was preferred in 88% of iterations.
DISCUSSION: rIOC increases costs without improving QALY when considering both choledocholithiasis and BDI. rIOC was preferred in high-risk choledocholithiasis, implying that judicious intraoperative management of choledocholithiasis is prudent in the decision to utilize IOC.