The vast majority of this piece is sensible and reasonable. Predictably, perhaps inevitably, the authors move into troubled waters when they discuss intra-operative cholangiography (IOC). Is there an issue in gastrointestinal surgery that engenders more controversy or discord? Inevitably, participants in this debate quote evidence to support their own prejudice. It is true that 'the routine use of IOC has been reported to reduce the incidence of bile duct injuries by clarifying the anatomy'. It is also true that numerous national and international series have shown that the use of IOC is not associated with any reduction in the risk or rate of bile duct injury. However, the numbers in these series range between 5 and 70,000 whereas the Flum study already referred to involves 1.5 million procedures.
展开▼
