An External Audit of Laparoscopic Cholecystectomy in the Steady State Performed in Medical Treatment Facilities of the Department of Defense

Wherry, David C.; Marohn, Michael R.; Malanoski, Michael P.; Hetz, Stephen P.; Rich, Norman M.

doi:10.1097/00000658-199608000-00006

Cited by 189 publications

(148 citation statements)

References 11 publications

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“…Although the open technique is a very safe method to enter the peritoneal cavity. perforating lesions have also been described by different authors, as well as in this series [7,17]. Those injuries may be related to the lysis of intraabdominal adhesions and perforations with the instruments used to create the minilaparotomy, whereas direct injuries from the blunt-tipped trocar appear to be rather less important.…”

Section: Discussionsupporting

confidence: 57%

“…However, at least two comparative studies have failed to show any timesaving advantages for closed laparoscopy, and in experi- enced hands, the leakage of carbon dioxide can be prevented by using a careful dissection technique [2,16]. The overall incidence of vascular and visceral injuries during laparoscopy, which includes TI, NI, and other intraoperative injuries caused by different instruments (electrocautery hook, scissors, and graspers), ranges from 0.05% to 1.05% and from 0.048% to 0.35%, respectively [3,5,6,17]. The wide range of reported incidences may reflect the use of different definitions.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, most studies are either retrospective series, reviews of the published data, or smaller case series [3]. Wherry et al reported on three access-related major bleeding complications among 10 vascular lesions (30%) [17]. Furthermore, 11 of 29 visceral injuries (51.7%) were caused by open-inserted trocars.…”

Section: Discussionmentioning

confidence: 99%

“…The open (Hasson) technique has been reported to be safer and is therefore increasingly favored by many surgeons [10]. However, even blunt introduction of the first trocar under direct vision cannot fully prevent every iatrogenic injury [3,8,17]. According to reports in the literature, the incidence of trocar and needle injuries is low, ranging from 0.03% to 0.2%; however, these complications may be underreported, and the true incidence may be even higher [3,5,6,9,11,17].…”

mentioning

confidence: 99%

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Trocar and Veress needle injuries during laparoscopy

Lauper²,

2001

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Background: Inadvertent lesions of the intraabdominal organs and vessels caused by trocars and Veress needles are rare but serious complications of laparoscopic surgery. Establishing the pneumoperitoneum is believed to be the most dangerous step. Methods: The Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) prospectively collected the data on 14,243 patients undergoing various standard laparoscopic procedures between 1995 and 1997. This database was investigated with special regard to intraabdominal complications caused by trocars and Veress needles. Results: There were 22 trocar and four needle injuries (incidence, 0.18%). Nineteen lesions involved visceral organs; the remaining seven were vessel injuries. The small bowel was the single most affected organ (six cases), followed by the large bowel and the liver (three cases each). All vascular lesions, except for one laceration of the right iliac artery, occurred as venous bleeding of either the greater omentum or the mesentery. Fourteen trocars were inserted under direct vision. Nineteen trocar injuries were recognized intraoperatively; diagnoses of two small bowel and one bladder injuries were made postoperatively. Needle injuries were all diagnosed intraoperatively. Only five injuries could be repaired laparoscopically; the remaining lesions were repaired openly. Four patients underwent an open reoperation, and another patient needed five reoperations. There was one death (4.0%). Conclusions: Trocar and needle injuries are rare complications of laparoscopy. However, if not recognized intraoperatively and repaired immediately, they induce increased morbidity and mortality. Both open and closed establishment of the pneumoperitoneum are related to a potential danger of perforating lesions, but inserting the first trocar under direct vision allows early recognition and immediate repair.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Trocar and Veress needle injuries during laparoscopy

Lauper²,

2001

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“…However, a vast majority of benign bile duct strictures occur after surgery on the gallbladder or biliary tree [3]. The widespread use of laparoscopic cholecystectomy (LC) has dramatically increased the incidence of bile duct injuries and strictures associated with cholecystectomy [4][5][6][7][8]. Benign strictures of the bile ducts represent a significant clinical problem, most often occurring in young patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Biliary Enteric Anastomosis in Benign Biliary Disorders

Singh

Arora

2012

Indian J Surg

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Evaluation of various methods of biliary enteric anastomosis in benign biliary diseases (BBD).A surgeon operating for BBD needs to improve the internal drainage of bile to prevent stasis and its backpressure effects. This is best obtained by biliary enteric anastomosis. A total of 121 cases of biliary enteric anastomosis in BBD were included in this study. The postoperative course and long-term outcome were studied prospectively. In the choledochoduodenostomy group, there were no leaks, no restrictures, and no mortality. Five (10.41 %) patients had cholangitis attacks and 2 (4.17 %) patients had sump syndrome. The choledochojejunostomy group had no leaks, no restrictures. Two (7.14 %) patients had repeated cholangitis and 2 (7.14 %) patients had sump syndrome, no mortality. The hepaticojejunostomy group had 3 cases of anastomotic leak of which 2 healed spontaneously and 1 needed resurgery. There was restricture in 2 cases, in which resurgery was successful-one death, no cholangiocarcinoma. Biliary enteric anastomosis is a safe and effective method for the management of BBD. The method should be selected according to the disease pathology and patient characteristics.

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Portoenterostomy

Pickleman

Marsan²,

Borge³

2000

Arch Surg

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Hypothesis: Portoenterostomy may be an effective treatment for patients sustaining a thermal injury to the hepatic duct confluence during laparoscopic cholecystectomy. Design: Case series. Setting: A tertiary care referral hospital. Patients: A consecutive series of 5 female patients referred and treated between November 13, 1991, and December 17, 1998. Ages ranged from 29 to 65 years. In addition to the ductal injuries at or above the hepatic duct confluence, 3 patients also had a major hepatic vascular injury. The patients were available for follow-up for 7 to 91 months postoperatively. Interventions: All patients underwent a portoenterostomy (Kasai procedure) with suturing of a Roux limb to the hepatic tissue surrounding the transected hepatic ducts. Transhepatic stents were inserted either preoperatively or postoperatively for rising liver enzyme levels in 4 patients. Main Outcome Measures: Symptoms and results of liver function tests. Results: Stents remained in place for 9 to 25 months in 4 patients. All 5 patients were symptom free and functioning normally; 3 had normal liver functions; 2 had mildly elevated alkaline phosphatase levels only. Conclusion: Portoenterostomy, usually in combination with postoperative stenting, may be an option to consider in life-threatening injuries involving the hepatic duct bifurcation in which standard biliary reconstruction techniques are not feasible.

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An External Audit of Laparoscopic Cholecystectomy in the Steady State Performed in Medical Treatment Facilities of the Department of Defense

Cited by 189 publications

References 11 publications

Trocar and Veress needle injuries during laparoscopy

Trocar and Veress needle injuries during laparoscopy

Evaluation of Biliary Enteric Anastomosis in Benign Biliary Disorders

Portoenterostomy

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