To the Editor Dr Sheffield and colleagues1 found that on a patient level, intraoperative cholangiography was associated with reduced risk of common bile duct injury during cholecystectomy, presumably by laying out a roadmap for the surgeon. This is consistent with other appropriately powered studies of the topic. A secondary, instrumental variable analysis was performed to control for the unmeasured confounding in this study based on administrative data, but it is unclear whether this was appropriate.
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