Selective or routine intraoperative cholangiography: A cost-effectiveness analysis

In a retrospective analysis of 819 patients operated on for gallbladder disease, the costs and mortality rates were compared for 2 different strategies: (a) routine use of intraoperative cholangiography, or (b) selective use of intraoperative cholangiography on patients fulfilling at least 1 of 4 common clinical criteria. Selective use led to lower costs and lower mortality rates. The main reason for this outcome was that the benefits of detecting more stones in the bile duct by the routine use of cholangiography were counterbalanced by an increase in costs and risks because false-positive operative cholangiograms led to a greater number of unnecessary choledochotomies.