Bile duct injury after laparoscopic cholecystectomy in hospitals with and without surgical residency programs: is there a difference?

Harrison, Vincent L.; Dolan, James P.; Pham, Thai H.; Diggs, Brian S.; Greenstein, Alexander J.; Sheppard, Brett C.; Hunter, John G.

doi:10.1007/s00464-010-1495-y

Cited by 18 publications

(17 citation statements)

References 11 publications

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“…2,3,[11][12][13][14] In order to better identify the extrahepatic biliary anatomy, many approaches have been described. The role of intraoperative cholangiography has shown in some studies to help decrease the incidence of BDI.…”

Section: Discussionmentioning

confidence: 99%

Importance of the Node of Calot in Gallbladder Neck Dissection: An Important Landmark in the Standardized Approach to the Laparoscopic Cholecystectomy

Ferzli

Timoney

Nazir

et al. 2015

Journal of Laparoendoscopic & Advanced Surgical Techniques

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The current rate of bile duct injury (BDI) after laparoscopic cholecystectomy is 0.4%, which is an unacceptable outcome. Several surgical approaches have been suggested to mitigate the occurrence of this dreaded complication. We propose a standardized approach, using Calot's node as a critical anatomical landmark to guide gallbladder dissection and avoid BDI. We retrospectively analyzed a prospectively gathered database of 907 laparoscopic cholecystectomies using this standardized approach in our practice over a 5-year period. To date we have had no BDI and no cystic duct leak. Therefore, we suggest identification of Calot's node as an additional method to avoid BDI during laparoscopic cholecystectomy.

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Section: Discussionmentioning

confidence: 99%

Importance of the Node of Calot in Gallbladder Neck Dissection: An Important Landmark in the Standardized Approach to the Laparoscopic Cholecystectomy

Ferzli

Timoney

Nazir

et al. 2015

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…Despite the establishment of formal training in laparoscopic surgery and the improvement in laparoscopic technology, still, there is a perception that performance of LCs in teaching hospitals with continuous inflow of trainees may be attended with difficult LC, increased conversion, and complication rates [8]. While several studies have reported a variable assembly of different preoperative and operative risk factors associated with difficult LC and conversion to open cholecystectomy [9–13], the performance of surgical trainees with different training backgrounds has not been adequately addressed.…”

Section: Introductionmentioning

confidence: 99%

Difficult Laparoscopic Cholecystectomy and Trainees: Predictors and Results in an Academic Teaching Hospital

Atta

Mohamed

Sewefy

et al. 2017

Gastroenterology Research and Practice

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Laparoscopic cholecystectomy (LC) is one of the first laparoscopic procedures performed by surgical trainees. This study aims to determine preoperative and/or intraoperative predictors of difficult LC and to compare complications of LC performed by trainees with that performed by trained surgeons. A cohort of 180 consecutive patients with cholelithiasis who underwent LC was analyzed. We used univariate and binary logistic regression analyses to predict factors associated with difficult LC. We compared the rate of complications of LCs performed by trainees and that performed by trained surgeons using Pearson's chi-square test. Patients with impacted stone in the neck of the gallbladder (GB) (OR, 5.0; 95% CI, 1.59–15.77), with adhesions in the Triangle of Calot (OR, 2.9; 95% CI, 1.27–6.83), or with GB rupture (OR, 3.4; 95% CI, 1.02–11.41) were more likely to experience difficult LC. There was no difference between trainees and trained surgeons in the rate of cystic artery injury (p = .144) or GB rupture (p = .097). However, operative time of LCs performed by trained surgeons was significantly shorter (median, 45 min; IQR, 30–70 min) compared with the surgical trainees' operative time (60 min; IQR, 50–90 min). Surgical trainees can perform difficult LC safely under supervision with no increase in complications albeit with mild increase in operative time.

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“…The most likely explanation for this is that patients are often referred to specialized tertiary centers in the late postoperative period with bile duct strictures following many failed endoscopic, radiologic, and/or surgical interventions. Our group has previously reported that the presence or absence of a surgical residency program in an institution does not increase the rates of BDI in LC [30]. In case of late referral, patients should always be carefully evaluated for signs of secondary biliary cirrhosis and portal hypertension.…”

Section: Discussionmentioning

confidence: 97%

Major bile duct injury requiring operative reconstruction after laparoscopic cholecystectomy: a follow-on study

et al. 2015

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LC continued to increase in utilization between 2001 and 2011. Although rates of BDI have decreased, the need for reconstruction continues to be associated with a significant mortality. In addition, mortality related to biliary reconstruction is also higher than previously published series and may reflect the complexity of managing biliary injury as well as the higher likelihood of these patients having comorbid conditions.

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Bile duct injury after laparoscopic cholecystectomy in hospitals with and without surgical residency programs: is there a difference?

Cited by 18 publications

References 11 publications

Importance of the Node of Calot in Gallbladder Neck Dissection: An Important Landmark in the Standardized Approach to the Laparoscopic Cholecystectomy

Importance of the Node of Calot in Gallbladder Neck Dissection: An Important Landmark in the Standardized Approach to the Laparoscopic Cholecystectomy

Difficult Laparoscopic Cholecystectomy and Trainees: Predictors and Results in an Academic Teaching Hospital

Major bile duct injury requiring operative reconstruction after laparoscopic cholecystectomy: a follow-on study

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