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To determine whether surgical residency training has influenced the occurrence of common bile duct injuries during laparoscopic cholecystectomy, and to asses the anatomic and technical details of bile duct injuries from the practices of surgeons trained in laparoscopic cholecystectomy after residency versus surgeons trained in laparoscopic cholecys...
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Background:
Primary closure after laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) is a safe and effective approach for treating cholecystolithiasis with choledocholithiasis. The aim of this study was to evaluate the learning curve of performing primary closure after LC+LCBDE.
Methods:
We retrospectively id...
Objective: To determine whether surgical residency training has influenced the occurrence of common bile duct injuries during laparoscopic cholecystectomy, and to asses the anatomic and technical details of bile duct injuries from the practices of surgeons trained in laparoscopic cholecystectomy after residency versus surgeons trained in laparoscop...
Background:
Complications following the insertion T-tube or stent after common bile duct exploration (CBDE) remain problematic in nowadays surgical era. Based on our knowledge, we did not find any meta-analysis intentionally evaluating the complications between both groups. At this moment, we aimed to analyze and compare both procedures' complicat...
Hipótesis: El aprendizaje de la técnica de colecistectomía laparoscópica durante los programas de entrenamiento de cirugía general disminuye la incidencia de lesiones de la vía biliar, si se compara con la incidencia de estas lesiones en cirujanos que aprendieron dicha técnica luego de graduados. Materiales y métodos: Trabajo descriptivo, con una m...
Citations
... In the realm of cholecystectomy, especially since the widespread adoption of laparoscopic techniques in the 1990s, efforts to enhance safety have been paramount. Initiatives such as the "critical view of safety" and the American Gastrointestinal and Endoscopic Surgeons (SAGES) safe cholecystectomy program have significantly reduced major complications like common bile duct injuries, which now occur at a rate of less than 1% [47][48][49][50][51][52]. This has contributed to maintaining low postoperative mortality rates for cholecystectomy, typically around or below 1% [53]. ...
This systematic review and meta-analysis aimed to evaluate the impact of prospective payment systems (PPSs) on cholecystectomy. A comprehensive literature review was conducted, examining studies published until December 2023. The review process focused on identifying research across major databases that reported critical outcomes such as length of stay (LOS), mortality, complications, admissions, readmissions, and costs following PPS for cholecystectomy. The studies were specifically selected for their relevance to the impact of PPS or the transition from fee-for-service (FFS) to PPS. The study analyzed six papers, with three eligible for meta-analysis, to assess the impact of the shift from FFS to PPS in laparoscopic and open cholecystectomy procedures. Our findings indicated no significant changes in LOS and mortality rates following the transition from FFS to PPS. Complication rates varied and were influenced by the diagnosis-related group categorization and surgeon cost profiles under episode-based payment. There was a slight increase in admissions and readmissions, and mixed effects on hospital costs and financial margins, suggesting varied responses to PPS for cholecystectomy procedures. The impact of PPS on cholecystectomy is nuanced and varies across different aspects of healthcare delivery. Our findings indicate a need for adaptable, patient-centered PPS models that balance economic efficiency with high-quality patient care. The study emphasizes the importance of considering specific surgical procedures and patient demographics in healthcare payment reforms.
... Bile duct injury (BDI) is a serious complication of cholecystectomy, occurring in 0.2-0.7% of laparoscopic procedures and 0.1-0.2% of open procedures [1,2]. BDI can occur due to anatomical misidentification, technical errors during dissection and clipping, thermal injury, or ischemia [3]. ...
Major bile duct injury during cholecystectomy often requires surgical reconstruction. The optimal timing of repair is debated. Systematic review and meta-analysis of observational studies comparing early (<14 days), intermediate (14 days-6 weeks), and late (>6 weeks) repair. Primary outcomes were postoperative morbidity, mortality, and stricture rates. Pooled risk ratios were calculated. A generalized linear model was used to estimate odds per time interval.
Results: 20 studies were included in the systematic review. Of these, data from 15 studies was included in the meta-analyses. The 20 included studies comprised a total of 3421 patients who underwent hepaticojejunostomy for bile duct injury. Early repair was associated with lower morbidity versus intermediate repair (RR 0.73, 95% CI 0.54-0.98). Delayed repair had lower morbidity versus intermediate (RR 1.50, 95% CI 1.16-1.93). Delayed repair had a lower stricture rate versus intermediate repair (RR 1.53, 95% CI 1.07-2.20). Mortality was not associated with timing.
Conclusions: Reconstruction between 2 and 6 weeks after bile duct injury should be avoided given the higher morbidity and stricture rates. Delayed repair after 6 weeks may be beneficial.
... Traditionally, open surgical removal had been reserved as a final therapeutic option for symptomatic cholelithiasis prior to the emergence of laparoscopy. In contrast, lithotripsy and cholecystectomy were more commonly favored as less invasive alternatives [4]. Laparoscopic procedures have demonstrated several advantages, including reduced pain, shorter recovery periods, less operative stress, and limited inflammatory responses. ...
Backgroud: Gallbladder diseases typically present as gallstones, inflammation, and cancer. Cholecystectomy has long been the established surgical approach for treating cholelithiasis and cholecystitis. The Critical View of Safety (CVS) technique is employed to identify key anatomical structures precisely, namely the cystic duct and the cystic artery. As such, this study aims to evaluate the effectiveness of the CVS method in laparoscopic cholecystectomy for preventing bile duct injuries. Material and methods: The study encompassed a cohort of 70 consecutive patients diagnosed with gallbladder disease. Thorough demographic information for each patient was meticulously collected. Preoperatively, a comprehensive hematological and biochemical profile analysis was conducted. Proficient and seasoned surgeons executed all surgical procedures. Subsequently, a post-operative evaluation was carried out for all patients. Results: In our study, aberrant anatomy was identified in two patients, while 68 patients exhibited typical anatomical structures. Notably, we achieved a 100 percent success rate in obtaining the Critical View of Safety for all patients in our study. However, aberrant anatomy was encountered exclusively in those two cases, necessitating a conversion to open cholecystectomy. Conclusion: The Critical View of Safety method for ductal identification is an effective technique.
... The same pictures were seen in other general surgery procedures including appendectomy, colectomy, and herniorrhaphy [3]. With additional experience, training, and improvement of surgical instruments, the early "learning curve" injuries were decreased [4]. Nowadays, MIS offers patients several benefits, such as smaller incisions, fast recovery times, and reduced pain/scarring. ...
Purpose
Minimally invasive surgery (MIS) offers patients several benefits, such as smaller incisions, and fast recovery times. General surgery residents should be trained in both open and MIS. We aimed to examine the trends of minimally invasive and open procedures performed by general surgery residents in Thailand.
Methods
A retrospective review of the Royal College of Surgeons of Thailand and Accreditation Council for Graduate Medical Education general surgery case logs from 2007 to 2018 was performed for common open and laparoscopic general surgery operations. The data were grouped by three time periods, which were 2007–2010, 2011–2014, and 2015–2018, and analyzed to explore changes in the operative trends.
Results
For Thai residents, the mean number of laparoscopic operations per person per year increased from 5.97 to 9.36 (56.78% increase) and open increased from 20.02 to 27.16 (35.67% increase). There was a significant increase in the average number of minimally invasive procedures performed among cholecystectomy (5.83, 6.57, 8.10; p < 0.001) and inguinal hernia repair (0.33, 0.35, 0.66; p < 0.001). Compared to general surgery residents in the United States, Thai residents had more experience with open appendectomy, but significantly less experience with all other operations/procedures.
Conclusion
The number of open and minimally invasive procedures performed or assisted by Thai general surgery residents has slowly increased, but generally lags behind residents in the United States. The Thai education program must be updated to improve residents’ technical skills in open and laparoscopic surgery to remain competitive with their global partners.
... Therefore, surgical trainees may find it more important to use CVS in this scenario. The supervising surgeon must confirm the CVS is secure before the surgical trainee can ligate the CD and cystic artery (114) . ...
Abstract Available at: http://srv4.eulc.edu.eg/eulc_v5/Libraries/Thesis/BrowseThesisPages.aspx?fn=ThesisPicBody&BibID=13013680&TotalNoOfRecord=155&PageNo=1&PageDirection=First
Paper published based on this thesis at: https://doi.org/10.1186/s12893-023-02301-2
... Laparoscopic cholecystectomy is a popular and routinely performed procedure in general abdominal surgery worldwide [3]. However, bile duct injury (BDI) is the most serious complication of laparoscopic cholecystectomy with an incidence of 0.2-0.7%, and significantly impacts increased morbidity, quality of life, and overall survival [4][5][6]. Additionally, BDI has significant medical-legal liabilities and frequently causes civil litigation involving personal injury claims. ...
Purpose
Bile duct injury (BDI) remains the most serious complication following cholecystectomy. However, the actual incidence of BDI in the Czech Republic remains unknown. Hence, we aimed to identify the incidence of major BDI requiring operative reconstruction after elective cholecystectomy in our region despite the prevailing modern 4 K Ultra HD laparoscopy and Critical View of Safety (CVS) standards implemented in daily surgical practice among the Czech population.
Methods
In the absence of a specific registry for BDI, we analysed data from The Czech National Patient Register of Reimbursed Healthcare Services, where all procedures are mandatorily recorded. We investigated 76,345 patients who were enrolled for at least a year and underwent elective cholecystectomy during the period from 2018–2021. In this cohort, we examined the incidence of major BDI following the reconstruction of the biliary tract and other complications.
Results
A total of 76,345 elective cholecystectomies were performed during the study period, and 186 major BDIs were registered (0.24%). Most elective cholecystectomies were performed laparoscopically (84.7%), with the remaining open (15.3%). The incidence of BDI was higher in the open surgery group (150 BDI/11700 cases/1.28%) than in laparoscopic cholecystectomy (36 BDI/64645 cases/0.06%). Furthermore, the total hospital stays with BDI after reconstruction was 13.6 days. However, the majority of laparoscopic elective cholecystectomies (57,914, 89.6%) were safe and standard procedures with no complications.
Conclusion
Our study corroborates the findings of previous nationwide studies. Therefore, though laparoscopic cholecystectomy is reliable, the risks of BDI cannot be eliminated.
... Bile duct injury with an estimated incidence of 0.4%-1.5% is a dangerous complication of cholecystectomy [2] . and with the introduction of laparoscopic cholecystectomy as the surgical treatment of choice for symptomatic cholelithiasis, the incidence of IBDI-which represents the most dramatic complications after open or laparoscopic cholecystectomy increased [3] . Comparing the incidence of IBDI in open cholecystectomy and laparoscopic cholecystectomy, despite increasing experience, IBDI incidence is still elevated in LC which is up to 3% compared with the rate of clinically relevant bile leaks after conventional open cholecystectomy ranging between 0.1 and 0.5 [4][5][6] . ...
... Approximately 25-38% of surgeons will cause a BDI during their careers. 23 The higher BDI rates early in the laparoscopic era were attributed to the learning curve and inexperience. A prospective study during the early laparoscopic era showed a decrease in BDI rates as surgeons performed more LC. ...
... 24 However, even with laparoscopic surgery now incorporated into surgical residencies, the rate of BDI has not improved significantly. Although most BDIs occur during a surgeon's first 100 cholecystectomies, up to one-third occur after 200 cases, indicating that it is more than inexperience that leads to BDI. 23 Way et al. retrospectively analyzed 252 BDIs following LC to determine the cause of the injury. They found that 97% of BDIs were due to visual misperception, and only 3% were due to faults in technical skills, knowledge, or judgment. ...
... According to our institutional protocol, in which experienced surgeons always attend these surgeries, the choice of operating surgeon (typically a resident) was determined by the patient's condition and instructor's judgment. BDI is less likely during residency teachings [23]. Further, Mangieri et al. demonstrated that cases of BDI occurring during resident teaching sessions were significantly less than those occurring when non-residents were performing the surgery [10]. ...
Background
Bailout surgery (BOS; partial cholecystectomy, open conversion, and fundus-first approach) has been recommended for difficult cases to ensure safe performance of cholecystectomy. However, the efficacy of BOS for preventing intraoperative massive bleeding and bile duct injury (BDI) remains unclear, especially in the context of acute cholecystitis (AC). This study aimed to retrospectively validate the feasibility of BOS for AC.
Methods
We enrolled 479 patients who underwent emergency cholecystectomies for AC between 2011 and 2021. Univariate and multivariate analyses were performed to detect the risk factors for BOS in patients with AC. Perioperative variables were compared between patients who underwent total cholecystectomy (TC) and those who underwent BOS. Propensity score matching analysis was performed to compare the two groups.
Results
Significant differences in American Society of Anesthesiologists physical status and Charlson Comorbidity Index scores, TG18 severity grading, white blood cell count, and albumin and C-reactive protein (CRP) levels were found between the TC and BOS groups. Preoperative CT imaging demonstrated severe inflammation evidenced by gallbladder wall thickness, enhancement of the liver bed, and duodenal edema in the BOS group compared to the TC group. Postoperative complications were significantly higher in the BOS group than in the TC group. Further, BDI was completely prevented by BOS. Multivariate analysis identified TG18 grade ≥ II, CRP ≥ 7.7, and duodenal edema as independent risk factors for BOS. After PSM analysis, postoperative complications were not worse in patients who underwent BOS rather than TC. Among BOS procedures, laparoscopic BOS (lap-BOS) was the most efficacious in preventing intraoperative blood loss and postoperative bile leakage.
Conclusion
Severity grading > II, elevated CRP levels, or duodenum edema revealed by CT were determined to be risk factors impeding total cholecystectomy. BOS is a safe, feasible, and efficacious procedure for preventing BDI. Among BOS procedures, lap-BOS showed better postoperative outcomes.
... LC is a minimally invasive surgery, but it can induce various surgi-cal complications that were uncommon in the era of open cholecystectomy. Bile duct injury is the most common complication associated with LC and has an incidence of around 1%, with diversity in terms of extent and location of the injuries [1][2][3][4]. Isolated injuries of the right anterior section (RAS) hepatic duct are a rare form of major bile duct www.e-alt.org Early postoperative imaging study findings. ...
... Most major bile duct injuries are detected during LC procedure or within a few days after surgery; they may also be occasionally detected late owing to the absence of significant symptoms and signs [1][2][3][4][5][6][7][8][9][10]. An isolated RAS duct injury is a rare complication because the RAS duct is typically not exposed during the LC procedure unless there is a rare aberrant anatomy. ...
