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In Reply The purpose of our study was to demonstrate that previous population-based studies reporting a patient-level association between intraoperative cholangiography and reduced common duct injury were subject to unmeasured confounding.1- 3 The causal direction is not clear when using administrative data because the intent of intraoperative cholangiography (to delineate anatomy or to detect injury) is unknown, and cholangiograms that are attempted—but unsuccessful—are not captured.
Riall TS, Sheffield KM, Kuo Y. Intraoperative Cholangiography During Cholecystectomy—Reply. JAMA. 2013;310(24):2674. doi:10.1001/jama.2013.282657