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July 23/30, 2003

Intraoperative Cholangiography and Risk of Common Bile Duct Injury—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(4):459-460. doi:10.1001/jama.290.4.459-a

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.

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