Buddingh, K. Tim

Nieuwenhuijs, Vincent B.

PubMed

University of Groningen

University of GroningenThe Critical View of Safety and Routine Intraoperative Cholangiography Complement EachOther as Safety Measures During CholecystectomyBuddingh, K. Tim; Nieuwenhuijs, Vincent B.Published in:Journal of Gastrointestinal SurgeryDOI:10.1007/s11605-011-1413-1IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2011Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Buddingh, K. T., & Nieuwenhuijs, V. B. (2011). The Critical View of Safety and Routine IntraoperativeCholangiography Complement Each Other as Safety Measures During Cholecystectomy. Journal ofGastrointestinal Surgery, 15(6), 1069-1070. https://doi.org/10.1007/s11605-011-1413-1CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 30-12-2025LETTER TO THE EDITORThe Critical View of Safety and Routine IntraoperativeCholangiography Complement Each Other as SafetyMeasures During CholecystectomyK. Tim Buddingh & Vincent B. NieuwenhuijsReceived: 8 July 2010 /Accepted: 5 January 2011 /Published online: 5 March 2011# The Author(s) 2011. This article is published with open access at Springerlink.comDear Editor,We read, with great interest, the study by Sanjay et al. inwhich they describe the outcome of 447 cholecystectomiesusing the critical view of safety (CVS) technique.1 Theauthors are to be congratulated for performing a medium-sized series of cholecystectomies for acute pathology withno bile duct injuries or leaks. We, too, fully endorse thepractice of careful dissection in the triangle of Calot andachievement of the CVS before clipping and dividing anytubular structures. However, rather than viewing the CVSas a replacement for routine intraoperative cholangiography(IOC), we feel that the two safety measures complementeach other.Sanjay and colleagues rightly argue that the largepopulation-based studies often used to propagate routineIOC date from the pre-CVS era.2,3 They continue tosuggest that this protective effect is therefore not to beexpected in modern surgical practice. In our point of view,this is an unlikely assertion.The CVS has been standard practice in the Netherlandsfor several years. A recent nationwide survey by our groupconfirmed that 98% of the Dutch surgeons use thistechnique.4 Nonetheless, common bile duct (CBD) injuriesremain a substantial problem in the Netherlands with anincidence that is estimated to be higher than the 0.5% oftenquoted in literature.5 Referrals to the largest tertiary referralcenter for bile duct injury (BDI) in the Netherlands show nodecreasing trend in the course of the past decade.6 In ourown center, eight CBD injuries (1.9%) occurred between2004 and 2006 despite the use of the CVS technique. InJanuary 2007, routine IOC was implemented, and no CBDinjuries were observed in the 3 years thereafter (p=0.004)(unpublished data).IOC reduces the risk of BDI in several ways at differentlevels ranging from revealing which duct has been cannulatedand demonstrating aberrant anatomy to increasing surgeoninsight into the diversity of anatomical variations. Theseadvantages cannot be replaced by CVS technique.It may be argued that IOC could be performedselectively in case of uncertain anatomy. There are twoarguments against this option. Firstly, it is unclear whethersurgeons can reliably identify patients at higher risk forBDI. Secondly, the importance of IOC becoming a routinepart of the procedure is that the whole team expects it, isready for it, and can plan for it. Only then does it fitsmoothly into the operative routine. Selectively performingIOC may lead to unfamiliarity with the technique and raisethe threshold to perform it.Sanjay et al. mention that opponents of IOC caution thatit is a potentially hazardous procedure. However, there isvirtually no evidence that IOC leads to complications ratherthan prevents them. The negligible amount of radiationreceived, too, is not a valid argument against its use in theadult population.7Although we applaud the efforts of Sanjay et al. tofurther advocate the CVS technique as optimal surgicaltechnique to prevent BDI, we feel that routine IOC shouldnot be abandoned as an additional safety measure. Bile ductinjury has serious, sometimes fatal, consequences.8 It is afrequently performed “routine” operation and such compli-cations are especially difficult for patients and surgeons toaccept. We advocate, therefore, that both the CVS tech-nique and routine IOC are used to complement each otherfor the safest way to remove the gallbladder.K. T. Buddingh :V. B. Nieuwenhuijs (*)Division of Abdominal Surgery, Department of Surgery,University Medical Centre Groningen,Groningen, The Netherlandse-mail: v.b.nieuwenhuijs@chir.umcg.nlJ Gastrointest Surg (2011) 15:1069–1070DOI 10.1007/s11605-011-1413-1Open Access This article is distributed under the terms of theCreative Commons Attribution Noncommercial License which permitsany noncommercial use, distribution, and reproduction in any medium,provided the original author(s) and source are credited.References1. Sanjay P, Fulke JL, Exon DJ. ‘Critical View of Safety’ as an Alternativeto Routine Intraoperative Cholangiography During LaparoscopicCholecystectomy for Acute Biliary Pathology. J Gastrointest Surg 2010.2. Fletcher DR, Hobbs MS, Tan P et al. Complications of cholecys-tectomy: risks of the laparoscopic approach and protective effectsof operative cholangiography: a population-based study. Ann Surg1999; 229:449–457.3. FlumDR,Dellinger EP, CheadleA et al. Intraoperative cholangiographyand risk of common bile duct injury during cholecystectomy. JAMA2003; 289:1639–1644.4. Buddingh KT, Hofker HS, Ten Cate Hoedemaker HO et al. Safetymeasures during cholecystectomy: results of a nationwide survey.World Journal of Surgery, in press.5. de Reuver PR, Rauws EA, Bruno MJ et al. Survival in bile ductinjury patients after laparoscopic cholecystectomy: a multidisci-plinary approach of gastroenterologists, radiologists, and surgeons.Surgery 2007; 142:1–9.6. de Reuver PR, Grossmann I, Busch OR et al. Referral patternand timing of repair are risk factors for complications afterreconstructive surgery for bile duct injury. Ann Surg 2007;245:763–770.7. Karthikesalingam A, Markar SR, Weerakkody R et al. Radiationexposure during laparoscopic cholecystectomy with routineintraoperative cholangiography. Surg Endosc 2009; 23:1845–1848.8. Gigot J, Etienne J, Aerts R et al. The dramatic reality of biliarytract injury during laparoscopic cholecystectomy. An anonymousmulticenter Belgian survey of 65 patients. Surg Endosc 1997;11:1171–1178.1070 J Gastrointest Surg (2011) 15:1069–1070

English

The Critical View of Safety and Routine Intraoperative Cholangiography Complement Each Other as Safety Measures During Cholecystectomy

   University of GroningenThe Critical View of Safety and Routine Intraoperative Cholangiography Complement EachOther as Safety Measures During CholecystectomyBuddingh, K. Tim; Nieuwenhuijs, Vincent B.Published in:Journal of Gastrointestinal SurgeryDOI:10.1007/s11605-011-1413-1IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2011Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Buddingh, K. T., & Nieuwenhuijs, V. B. (2011). The Critical View of Safety and Routine IntraoperativeCholangiography Complement Each Other as Safety Measures During Cholecystectomy. Journal ofGastrointestinal Surgery, 15(6), 1069-1070. https://doi.org/10.1007/s11605-011-1413-1CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 12-11-2019LETTER TO THE EDITORThe Critical View of Safety and Routine IntraoperativeCholangiography Complement Each Other as SafetyMeasures During CholecystectomyK. Tim Buddingh & Vincent B. NieuwenhuijsReceived: 8 July 2010 /Accepted: 5 January 2011 /Published online: 5 March 2011# The Author(s) 2011. This article is published with open access at Springerlink.comDear Editor,We read, with great interest, the study by Sanjay et al. inwhich they describe the outcome of 447 cholecystectomiesusing the critical view of safety (CVS) technique.1 Theauthors are to be congratulated for performing a medium-sized series of cholecystectomies for acute pathology withno bile duct injuries or leaks. We, too, fully endorse thepractice of careful dissection in the triangle of Calot andachievement of the CVS before clipping and dividing anytubular structures. However, rather than viewing the CVSas a replacement for routine intraoperative cholangiography(IOC), we feel that the two safety measures complementeach other.Sanjay and colleagues rightly argue that the largepopulation-based studies often used to propagate routineIOC date from the pre-CVS era.2,3 They continue tosuggest that this protective effect is therefore not to beexpected in modern surgical practice. In our point of view,this is an unlikely assertion.The CVS has been standard practice in the Netherlandsfor several years. A recent nationwide survey by our groupconfirmed that 98% of the Dutch surgeons use thistechnique.4 Nonetheless, common bile duct (CBD) injuriesremain a substantial problem in the Netherlands with anincidence that is estimated to be higher than the 0.5% oftenquoted in literature.5 Referrals to the largest tertiary referralcenter for bile duct injury (BDI) in the Netherlands show nodecreasing trend in the course of the past decade.6 In ourown center, eight CBD injuries (1.9%) occurred between2004 and 2006 despite the use of the CVS technique. InJanuary 2007, routine IOC was implemented, and no CBDinjuries were observed in the 3 years thereafter (p=0.004)(unpublished data).IOC reduces the risk of BDI in several ways at differentlevels ranging from revealing which duct has been cannulatedand demonstrating aberrant anatomy to increasing surgeoninsight into the diversity of anatomical variations. Theseadvantages cannot be replaced by CVS technique.It may be argued that IOC could be performedselectively in case of uncertain anatomy. There are twoarguments against this option. Firstly, it is unclear whethersurgeons can reliably identify patients at higher risk forBDI. Secondly, the importance of IOC becoming a routinepart of the procedure is that the whole team expects it, isready for it, and can plan for it. Only then does it fitsmoothly into the operative routine. Selectively performingIOC may lead to unfamiliarity with the technique and raisethe threshold to perform it.Sanjay et al. mention that opponents of IOC caution thatit is a potentially hazardous procedure. However, there isvirtually no evidence that IOC leads to complications ratherthan prevents them. The negligible amount of radiationreceived, too, is not a valid argument against its use in theadult population.7Although we applaud the efforts of Sanjay et al. tofurther advocate the CVS technique as optimal surgicaltechnique to prevent BDI, we feel that routine IOC shouldnot be abandoned as an additional safety measure. Bile ductinjury has serious, sometimes fatal, consequences.8 It is afrequently performed “routine” operation and such compli-cations are especially difficult for patients and surgeons toaccept. We advocate, therefore, that both the CVS tech-nique and routine IOC are used to complement each otherfor the safest way to remove the gallbladder.K. T. Buddingh :V. B. Nieuwenhuijs (*)Division of Abdominal Surgery, Department of Surgery,University Medical Centre Groningen,Groningen, The Netherlandse-mail: v.b.nieuwenhuijs@chir.umcg.nlJ Gastrointest Surg (2011) 15:1069–1070DOI 10.1007/s11605-011-1413-1Open Access This article is distributed under the terms of theCreative Commons Attribution Noncommercial License which permitsany noncommercial use, distribution, and reproduction in any medium,provided the original author(s) and source are credited.References1. Sanjay P, Fulke JL, Exon DJ. ‘Critical View of Safety’ as an Alternativeto Routine Intraoperative Cholangiography During LaparoscopicCholecystectomy for Acute Biliary Pathology. J Gastrointest Surg 2010.2. Fletcher DR, Hobbs MS, Tan P et al. Complications of cholecys-tectomy: risks of the laparoscopic approach and protective effectsof operative cholangiography: a population-based study. Ann Surg1999; 229:449–457.3. FlumDR,Dellinger EP, CheadleA et al. Intraoperative cholangiographyand risk of common bile duct injury during cholecystectomy. JAMA2003; 289:1639–1644.4. Buddingh KT, Hofker HS, Ten Cate Hoedemaker HO et al. Safetymeasures during cholecystectomy: results of a nationwide survey.World Journal of Surgery, in press.5. de Reuver PR, Rauws EA, Bruno MJ et al. Survival in bile ductinjury patients after laparoscopic cholecystectomy: a multidisci-plinary approach of gastroenterologists, radiologists, and surgeons.Surgery 2007; 142:1–9.6. de Reuver PR, Grossmann I, Busch OR et al. Referral patternand timing of repair are risk factors for complications afterreconstructive surgery for bile duct injury. Ann Surg 2007;245:763–770.7. Karthikesalingam A, Markar SR, Weerakkody R et al. Radiationexposure during laparoscopic cholecystectomy with routineintraoperative cholangiography. Surg Endosc 2009; 23:1845–1848.8. Gigot J, Etienne J, Aerts R et al. The dramatic reality of biliarytract injury during laparoscopic cholecystectomy. An anonymousmulticenter Belgian survey of 65 patients. Surg Endosc 1997;11:1171–1178.1070 J Gastrointest Surg (2011) 15:1069–1070

K. Tim Buddingh

Vincent B. Nieuwenhuijs

Springer - Publisher Connector

NARCIS 

ARTS repository - University of Groningen

   University of GroningenThe Critical View of Safety and Routine Intraoperative Cholangiography Complement EachOther as Safety Measures During CholecystectomyBuddingh, K. Tim; Nieuwenhuijs, Vincent B.Published in:Journal of Gastrointestinal SurgeryDOI:10.1007/s11605-011-1413-1IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2011Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Buddingh, K. T., & Nieuwenhuijs, V. B. (2011). The Critical View of Safety and Routine IntraoperativeCholangiography Complement Each Other as Safety Measures During Cholecystectomy. Journal ofGastrointestinal Surgery, 15(6), 1069-1070. https://doi.org/10.1007/s11605-011-1413-1CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.LETTER TO THE EDITORThe Critical View of Safety and Routine IntraoperativeCholangiography Complement Each Other as SafetyMeasures During CholecystectomyK. Tim Buddingh & Vincent B. NieuwenhuijsReceived: 8 July 2010 /Accepted: 5 January 2011 /Published online: 5 March 2011# The Author(s) 2011. This article is published with open access at Springerlink.comDear Editor,We read, with great interest, the study by Sanjay et al. inwhich they describe the outcome of 447 cholecystectomiesusing the critical view of safety (CVS) technique.1 Theauthors are to be congratulated for performing a medium-sized series of cholecystectomies for acute pathology withno bile duct injuries or leaks. We, too, fully endorse thepractice of careful dissection in the triangle of Calot andachievement of the CVS before clipping and dividing anytubular structures. However, rather than viewing the CVSas a replacement for routine intraoperative cholangiography(IOC), we feel that the two safety measures complementeach other.Sanjay and colleagues rightly argue that the largepopulation-based studies often used to propagate routineIOC date from the pre-CVS era.2,3 They continue tosuggest that this protective effect is therefore not to beexpected in modern surgical practice. In our point of view,this is an unlikely assertion.The CVS has been standard practice in the Netherlandsfor several years. A recent nationwide survey by our groupconfirmed that 98% of the Dutch surgeons use thistechnique.4 Nonetheless, common bile duct (CBD) injuriesremain a substantial problem in the Netherlands with anincidence that is estimated to be higher than the 0.5% oftenquoted in literature.5 Referrals to the largest tertiary referralcenter for bile duct injury (BDI) in the Netherlands show nodecreasing trend in the course of the past decade.6 In ourown center, eight CBD injuries (1.9%) occurred between2004 and 2006 despite the use of the CVS technique. InJanuary 2007, routine IOC was implemented, and no CBDinjuries were observed in the 3 years thereafter (p=0.004)(unpublished data).IOC reduces the risk of BDI in several ways at differentlevels ranging from revealing which duct has been cannulatedand demonstrating aberrant anatomy to increasing surgeoninsight into the diversity of anatomical variations. Theseadvantages cannot be replaced by CVS technique.It may be argued that IOC could be performedselectively in case of uncertain anatomy. There are twoarguments against this option. Firstly, it is unclear whethersurgeons can reliably identify patients at higher risk forBDI. Secondly, the importance of IOC becoming a routinepart of the procedure is that the whole team expects it, isready for it, and can plan for it. Only then does it fitsmoothly into the operative routine. Selectively performingIOC may lead to unfamiliarity with the technique and raisethe threshold to perform it.Sanjay et al. mention that opponents of IOC caution thatit is a potentially hazardous procedure. However, there isvirtually no evidence that IOC leads to complications ratherthan prevents them. The negligible amount of radiationreceived, too, is not a valid argument against its use in theadult population.7Although we applaud the efforts of Sanjay et al. tofurther advocate the CVS technique as optimal surgicaltechnique to prevent BDI, we feel that routine IOC shouldnot be abandoned as an additional safety measure. Bile ductinjury has serious, sometimes fatal, consequences.8 It is afrequently performed “routine” operation and such compli-cations are especially difficult for patients and surgeons toaccept. We advocate, therefore, that both the CVS tech-nique and routine IOC are used to complement each otherfor the safest way to remove the gallbladder.K. T. Buddingh :V. B. Nieuwenhuijs (*)Division of Abdominal Surgery, Department of Surgery,University Medical Centre Groningen,Groningen, The Netherlandse-mail: v.b.nieuwenhuijs@chir.umcg.nlJ Gastrointest Surg (2011) 15:1069–1070DOI 10.1007/s11605-011-1413-1Open Access This article is distributed under the terms of theCreative Commons Attribution Noncommercial License which permitsany noncommercial use, distribution, and reproduction in any medium,provided the original author(s) and source are credited.References1. Sanjay P, Fulke JL, Exon DJ. ‘Critical View of Safety’ as an Alternativeto Routine Intraoperative Cholangiography During LaparoscopicCholecystectomy for Acute Biliary Pathology. J Gastrointest Surg 2010.2. Fletcher DR, Hobbs MS, Tan P et al. Complications of cholecys-tectomy: risks of the laparoscopic approach and protective effectsof operative cholangiography: a population-based study. Ann Surg1999; 229:449–457.3. FlumDR,Dellinger EP, CheadleA et al. Intraoperative cholangiographyand risk of common bile duct injury during cholecystectomy. JAMA2003; 289:1639–1644.4. Buddingh KT, Hofker HS, Ten Cate Hoedemaker HO et al. Safetymeasures during cholecystectomy: results of a nationwide survey.World Journal of Surgery, in press.5. de Reuver PR, Rauws EA, Bruno MJ et al. Survival in bile ductinjury patients after laparoscopic cholecystectomy: a multidisci-plinary approach of gastroenterologists, radiologists, and surgeons.Surgery 2007; 142:1–9.6. de Reuver PR, Grossmann I, Busch OR et al. Referral patternand timing of repair are risk factors for complications afterreconstructive surgery for bile duct injury. Ann Surg 2007;245:763–770.7. Karthikesalingam A, Markar SR, Weerakkody R et al. Radiationexposure during laparoscopic cholecystectomy with routineintraoperative cholangiography. Surg Endosc 2009; 23:1845–1848.8. Gigot J, Etienne J, Aerts R et al. The dramatic reality of biliarytract injury during laparoscopic cholecystectomy. An anonymousmulticenter Belgian survey of 65 patients. Surg Endosc 1997;11:1171–1178.1070 J Gastrointest Surg (2011) 15:1069–1070

University of Groningen Research Database

  
 University of Groningen
The Critical View of Safety and Routine Intraoperative Cholangiography Complement Each
Other as Safety Measures During Cholecystectomy
Buddingh, K. Tim; Nieuwenhuijs, Vincent B.
Published in:
Journal of Gastrointestinal Surgery
DOI:
10.1007/s11605-011-1413-1
IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from
it. Please check the document version below.
Document Version
Publisher's PDF, also known as Version of record
Publication date:
2011
Link to publication in University of Groningen/UMCG research database
Citation for published version (APA):
Buddingh, K. T., & Nieuwenhuijs, V. B. (2011). The Critical View of Safety and Routine Intraoperative
Cholangiography Complement Each Other as Safety Measures During Cholecystectomy. Journal of
Gastrointestinal Surgery, 15(6), 1069-1070. https://doi.org/10.1007/s11605-011-1413-1
Copyright
Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the
author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).
Take-down policy
If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately
and investigate your claim.
Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the
number of authors shown on this cover page is limited to 10 maximum.
Download date: 22-05-2019
LETTER TO THE EDITOR
The Critical View of Safety and Routine Intraoperative
Cholangiography Complement Each Other as Safety
Measures During Cholecystectomy
K. Tim Buddingh & Vincent B. Nieuwenhuijs
Received: 8 July 2010 /Accepted: 5 January 2011 /Published online: 5 March 2011
# The Author(s) 2011. This article is published with open access at Springerlink.com
Dear Editor,
We read, with great interest, the study by Sanjay et al. in
which they describe the outcome of 447 cholecystectomies
using the critical view of safety (CVS) technique.1 The
authors are to be congratulated for performing a medium-
sized series of cholecystectomies for acute pathology with
no bile duct injuries or leaks. We, too, fully endorse the
practice of careful dissection in the triangle of Calot and
achievement of the CVS before clipping and dividing any
tubular structures. However, rather than viewing the CVS
as a replacement for routine intraoperative cholangiography
(IOC), we feel that the two safety measures complement
each other.
Sanjay and colleagues rightly argue that the large
population-based studies often used to propagate routine
IOC date from the pre-CVS era.2,3 They continue to
suggest that this protective effect is therefore not to be
expected in modern surgical practice. In our point of view,
this is an unlikely assertion.
The CVS has been standard practice in the Netherlands
for several years. A recent nationwide survey by our group
confirmed that 98% of the Dutch surgeons use this
technique.4 Nonetheless, common bile duct (CBD) injuries
remain a substantial problem in the Netherlands with an
incidence that is estimated to be higher than the 0.5% often
quoted in literature.5 Referrals to the largest tertiary referral
center for bile duct injury (BDI) in the Netherlands show no
decreasing trend in the course of the past decade.6 In our
own center, eight CBD injuries (1.9%) occurred between
2004 and 2006 despite the use of the CVS technique. In
January 2007, routine IOC was implemented, and no CBD
injuries were observed in the 3 years thereafter (p=0.004)
(unpublished data).
IOC reduces the risk of BDI in several ways at different
levels ranging from revealing which duct has been cannulated
and demonstrating aberrant anatomy to increasing surgeon
insight into the diversity of anatomical variations. These
advantages cannot be replaced by CVS technique.
It may be argued that IOC could be performed
selectively in case of uncertain anatomy. There are two
arguments against this option. Firstly, it is unclear whether
surgeons can reliably identify patients at higher risk for
BDI. Secondly, the importance of IOC becoming a routine
part of the procedure is that the whole team expects it, is
ready for it, and can plan for it. Only then does it fit
smoothly into the operative routine. Selectively performing
IOC may lead to unfamiliarity with the technique and raise
the threshold to perform it.
Sanjay et al. mention that opponents of IOC caution that
it is a potentially hazardous procedure. However, there is
virtually no evidence that IOC leads to complications rather
than prevents them. The negligible amount of radiation
received, too, is not a valid argument against its use in the
adult population.7
Although we applaud the efforts of Sanjay et al. to
further advocate the CVS technique as optimal surgical
technique to prevent BDI, we feel that routine IOC should
not be abandoned as an additional safety measure. Bile duct
injury has serious, sometimes fatal, consequences.8 It is a
frequently performed “routine” operation and such compli-
cations are especially difficult for patients and surgeons to
accept. We advocate, therefore, that both the CVS tech-
nique and routine IOC are used to complement each other
for the safest way to remove the gallbladder.
K. T. Buddingh :V. B. Nieuwenhuijs (*)
Division of Abdominal Surgery, Department of Surgery,
University Medical Centre Groningen,
Groningen, The Netherlands
e-mail: v.b.nieuwenhuijs@chir.umcg.nl
J Gastrointest Surg (2011) 15:1069–1070
DOI 10.1007/s11605-011-1413-1
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which permits
any noncommercial use, distribution, and reproduction in any medium,
provided the original author(s) and source are credited.
References
1. Sanjay P, Fulke JL, Exon DJ. ‘Critical View of Safety’ as an Alternative
to Routine Intraoperative Cholangiography During Laparoscopic
Cholecystectomy for Acute Biliary Pathology. J Gastrointest Surg 2010.
2. Fletcher DR, Hobbs MS, Tan P et al. Complications of cholecys-
tectomy: risks of the laparoscopic approach and protective effects
of operative cholangiography: a population-based study. Ann Surg
1999; 229:449–457.
3. FlumDR,Dellinger EP, CheadleA et al. Intraoperative cholangiography
and risk of common bile duct injury during cholecystectomy. JAMA
2003; 289:1639–1644.
4. Buddingh KT, Hofker HS, Ten Cate Hoedemaker HO et al. Safety
measures during cholecystectomy: results of a nationwide survey.
World Journal of Surgery, in press.
5. de Reuver PR, Rauws EA, Bruno MJ et al. Survival in bile duct
injury patients after laparoscopic cholecystectomy: a multidisci-
plinary approach of gastroenterologists, radiologists, and surgeons.
Surgery 2007; 142:1–9.
6. de Reuver PR, Grossmann I, Busch OR et al. Referral pattern
and timing of repair are risk factors for complications after
reconstructive surgery for bile duct injury. Ann Surg 2007;
245:763–770.
7. Karthikesalingam A, Markar SR, Weerakkody R et al. Radiation
exposure during laparoscopic cholecystectomy with routine
intraoperative cholangiography. Surg Endosc 2009; 23:1845–
1848.
8. Gigot J, Etienne J, Aerts R et al. The dramatic reality of biliary
tract injury during laparoscopic cholecystectomy. An anonymous
multicenter Belgian survey of 65 patients. Surg Endosc 1997;
11:1171–1178.
1070 J Gastrointest Surg (2011) 15:1069–1070


Crossref

Journal of Gastrointestinal Surgery

Cate Hoedemaker HO et al. Safety measures during cholecystectomy: results of a nationwide survey. World Journal of Surgery,

Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg

Critical View of Safety’ as an Alternative to Routine Intraoperative Cholangiography During Laparoscopic Cholecystectomy for Acute Biliary Pathology.

Radiation exposure during laparoscopic cholecystectomy with routine intraoperative cholangiography. Surg Endosc

Referral pattern and timing of repair are risk factors for complications after reconstructive surgery for bile duct injury. Ann Surg

risk of common bile duct injury during cholecystectomy. JAMA

Survival in bile duct injury patients after laparoscopic cholecystectomy: a multidisciplinary approach of gastroenterologists, radiologists, and surgeons. Surgery

The dramatic reality of biliary tract injury during laparoscopic cholecystectomy. An anonymous multicenter Belgian survey of 65 patients. Surg Endosc 1997; 11:1171–1178. 1070 J Gastrointest Surg

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The Critical View of Safety and Routine Intraoperative Cholangiography Complement Each Other as Safety Measures During Cholecystectomy

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University of Groningen Research Database

Crossref

ARTS repository - University of Groningen

University of Groningen