Forty-nine patients with clinical signs of acute cholecystitis underwent conventional and computed tomographic cholangiography. Among 39 patients with signs of contrast medium in the biliary system at...

This study compares perioperative outcomes of cholecystectomy between surgeons who routinely vs selectively perform intraoperative cholangiogram.

Clinicaltrials.gov identifier NCT02351492: Radiological Investigation of Bile Duct Obstruction (RIBO).

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Background:Intraoperative cholangiography (IOC) is widely used during cholecystectomy to define biliary anatomy and potentially reduce bile duct...

Background There are multiple intraoperative imaging techniques used to increase safety during laparoscopic cholecystectomy, including intraoperative cholangiography (IOC), fluorescence imaging (FI) with indocyanine green (ICG), and laparoscopic ultrasound (LUS). This guideline addresses the optimal intraoperative imaging technique during laparoscopic cholecystectomy for benign biliary disease. Methods A systematic review was conducted to address five key questions regarding the use of intraoperative imaging of the common bile duct. These results were then presented to a panel of practicing surgeons who formulated recommendations based on the best available evidence. Results Conditional recommendations were made in favor of performing IOC in adult and pediatric patients and doing so routinely rather than selectively, IOC rather than FI with ICG, and either IOC or LUS. Conclusions These recommendations should provide guidance regarding the use of intraoperative imaging techniques during laparoscopic cholecystectomy. This guideline also identifies important areas where the future research should focus to strengthen the evidence base.

This cohort study examines data from a large multicenter dataset to evaluate the association between intraoperative use of indocyanine green and common bile duct injury among patients who had laparoscopic cholecystectomy.

This cohort study examines data from a large multicenter dataset to evaluate the association between intraoperative use of indocyanine green and common bile duct injury among patients who had laparoscopic cholecystectomy.

This cohort study examines data from a large multicenter dataset to evaluate the association between intraoperative use of indocyanine green and common bile duct injury among patients who had laparosc...

A prospective trial indicates a new ultrasound technique may improve detection of bile leaks during liver surgery.Contrast-enhanced intraoperative ultrasonic cholangiography was technically successful in 86.2% of patients.Postoperative bile leak rate was 17.2%, with most detected intraoperatively.This approach could enhance surgical safety but requires further validation to confirm its impact on patient outcomes.No adverse events related

Background Bile leak (BL) remains a major complication after liver resection and is associated with substantial postoperative morbidity. Conventional dye-based tests can identify visible leakage from the transection surface, but whether the injected reagent has adequately reached peripheral intrahepatic ducts adjacent to the cut surface is often uncertain. We evaluated the feasibility and safety of a novel BL test using contrast-enhanced intraoperative ultrasonic cholangiography (CE-IOUSC) for real-time confirmation of intrabiliary reagent filling. Methods This prospective single-arm trial included 29 patients undergoing open liver resection under the finalized protocol between March 2021 and February 2024. A reagent consisting of diluted Sonazoid, indigo carmine, and saline was injected through a cystic-duct catheter while the distal common bile duct was clamped. Ductal filling near the transection plane was assessed using contrast harmonic ultrasonography during and immediately after manual divided injection. Outcomes included technical success, postoperative BL, injection-related adverse events, and exploratory comparison of postoperative liver enzymes with a historical conventional-test cohort. Results CE-IOUSC testing was technically successful in 25 of 29 patients (86.2%). The median total injected volume was 5 mL (range 2–22 mL), and the median number of divided injections was 2 (range 1–6). Intraoperative BL was detected and sutured in 3 patients. Postoperative BL occurred in 5 patients (17.2%): 4 after technical success and 1 after technical failure. No adverse events related to intrabiliary reagent injection were observed. Postoperative AST and ALT elevations were significantly lower than in the historical cohort, although this comparison was exploratory. Conclusions CE-IOUSC-based BL testing was feasible and safe in open liver resection and enabled real-time confirmation of intrabiliary reagent filling near the transection surface. Its clinical efficacy in reducing postoperative BL or liver injury remains unproven and should be evaluated in future comparative studies.

Category: Critical Care Nursing  Hyperbilirubinemia is multifactorial and although laboratory values evaluating the production and excretion of bilirubin can guide the workup, a liver biopsy or cholangiography is necessary when no other diagnosis can be confirmed.

Objective The presence of pancreaticobiliary maljunction (PBM) in pediatric patients with congenital choledochal malformation significantly impacts clinical management and surgical decision-making. Current preoperative evaluation of PBM coexistence remains challenging in children, while intraoperative cholangiography does not consistently provide diagnostic-quality imaging. This study aims to develop machine learning-based algorithm models for detecting pancreaticobiliary maljunction (PBM) in children with congenital choledochal malformation. Methods We conducted a retrospective study utilizing data from patients with congenital choledochal malformation treated at our center between January 2019 and January 2024. Demographic characteristics, clinical features, and preoperative laboratory parameters were processed through rigorous data curation and feature engineering pipelines. Cases were allocated via random sampling into training (80%) and hold-out test (20%) cohorts, maintaining strict separation between training and test cohorts. Seven machine learning algorithms - Logistic Regression (LR), Support Vector Machine (SVM), Random Forest (RF), eXtreme Gradient Boosting (XGBoost), Adaptive Boosting (AdaBoost), Light Gradient Boosting Machine (LightGBM), and K-Nearest Neighbors (KNN) - were implemented with five-fold cross-validation. An ensemble voting classifier was specifically constructed using these models. Model performance was quantified through comprehensive metrics including area under the ROC curve (AUC), sensitivity, specificity, positive/negative predictive values, accuracy, precision, recall, and F1-score. This study employed the nonparametric bootstrap method to estimate the confidence interval for the area under the receiver operating characteristic curve (AUC). SHapley Additive exPlanations (SHAP) was employed for model interpretability, with feature importance rankings determined by absolute SHAP value magnitudes. Results In a cohort of 803 pediatric patients with congenital choledochal malformation, 628 (78.2%) demonstrated concurrent pancreaticobiliary maljunction. We developed a detection model incorporating 43 clinical features, with Random Forest showing optimal performance. An ensemble voting classifier integrating seven machine learning algorithms achieved enhanced discriminative performance (AUC: 0.87 (0.81, 0.92); Recall: 0.91 (0.85, 0.95); F1-score: 0.91 (0.87, 0.94)). Key features contributing to PBM detection included: laboratory markers and clinical parameters. Conclusion By integrating preoperative clinical symptoms and laboratory parameters, machine learning algorithms demonstrated significant detection capability in identifying PBM among pediatric congenital choledochal malformation patients, with the RF model achieving superior performance metrics among all base models. The developed ensemble voting classifier provides valuable preoperative guidance for surgical planning and clinical management, enabling detection of PBM comorbidity before surgery in congenital choledochal malformation cases.

In patients with prior abdominal surgeries, indocyanine green (ICG) fluorescence cholangiography significantly enhances laparoscopic bile duct exploration. A study involving 122 matched patients revealed that the ICG group experienced an 88.5% incidence of positive fluorescence, reducing the time to identify the common bile duct and overall surgical duration. Additionally, the ICG cohort had less intraoperative

Surgeons now have clear guidance favoring routine intraoperative cholangiography (IOC) during laparoscopic cholecystectomy for benign biliary disease. Conditional recommendations highlight IOC's superiority over fluorescence imaging and confirm its use in both adult and pediatric patients. Additionally, laparoscopic ultrasound remains a viable option. The guidelines stem from a systematic review and input from practicing surgeons, aiming

📅 Publication Date: April 2026 | ⏳ Forecast Period: 2026-2033 📊 Market Intelligence Overview | Access Research Sample | Explore Full Market Study United States Percutaneous Transhepatic Cholangiograph...

Randomized trial: ICG cholangiography shortens operative time, improves visualization, and reduces risks in laparoscopic cholecystectomy.

ICG fluorescence cholangiography enhances bile duct visualization, improves critical view of safety, and ensures safe laparoscopic cholecystectomy in acute cholecystitis patients.