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To the Editor: Dr Flum and colleagues¹ found that intraoperative cholangiography (IOC) during cholecystectomy decreased the rate of common bile duct injury (CBDI) from 0.58% to 0.39%. From these results one can compute an absolute risk reduction of 0.0019, and a number needed to treat (NNT) of 526. That is, 526 patients would need to have IOC (each with approximately one half hour of extra operating room time, the expense of a radiology technician, radiologist, and prorated cost of the fluoroscope and supplies) to avoid a single case of CBDI. The authors also do not consider the risk of complications from IOC and its added time under anesthesia.

There are a number of risk factors for CBDI, including obesity, severe inflammation, adhesions, intraoperative hemorrhage, and poorly delineated anatomy. The use of IOC helps prevent CBDI for only the last of these risk factors. The authors' administrative database, however, could not . . . [Full Text of this Article]

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