Comparison of treatment costs of laparoscopic and open surgery.

Introduction: Common bile duct injury (CBDI) is a severe complication of laparoscopic cholecystectomy (LC). To minimize its occurrence, SAGES established the Safe Cholecystectomy Program (SCP) with 6 rules to follow during surgery. Aim: To assess the knowledge of SCP among European surgeons and their opinion on its usefulness. Material and methods: Data were gathered using questionnaires during surgical conferences in Poland and Denmark. The questionnaire asked about the surgeon's experience in cholecystectomy and the number of complications in the form of CBDI. It asked about the surgeon's opinion on the usefulness of SCP rules on a 10-point scale. A comparison between specialists and residents was performed. The study has been registered in the ClinicalTrials. gov-NCT03155321. Results: One hundred eighty-four questionnaires were gathered. One hundred fourteen (61.96%) specialists (72.8% male, mean age: 50 years) and 70 (38.04%) residents (56% male, mean age: 34 years) completed the questionnaire. Mean work experience was 22 years among specialists and 4.5 years among residents. A high percentage of specialists have experienced CBDI (46% vs. 17% of residents, p = 0.014). More specialists are familiar with the SCP than residents (49.3% vs. 21.7%, p = 0.021). Significant differences in the mean usefulness score were observed for three rules: rules 2 and 6 were found more useful by residents (mean score: 7.07 vs. 6.01, p = 0.025 and 8.70 vs. 8.27, p < 0.001), and rule 3 was found more useful by specialists (mean: 8.73 vs. 8.36, p < 0.001). Conclusions: The awareness of the SCP in Europe is low. Participants consider the rules of the SCP to be useful during surgery, although there are differences in the usefulness scores between the groups. An educational program to promote and further implement the SCP should be established.

Section: Discussionmentioning

confidence: 99%

Evaluation of the usefulness of the SAGES Safe Cholecystectomy Program from the viewpoint of the European surgeon.

Bogacki¹,

Krzak²,

Gotfryd-Bugajska³

et al. 2019

“…Laparoscopic surgery results in minimal injury to the tissues, smaller post-operative wounds and less post-operative pain, which are associated with a lower risk of infection and post-operative hernia. The resulting shorter hospitalization time may lead to a reduction of the treatment costs [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Schwannoma in the porta hepatis - laparoscopic excision under laparoscopic ultrasound guidance.

Sebastian

Sroczyński

Donizy

et al. 2017

Schwannomas are usually benign tumors attached to peripheral nerves and are rarely found in the gastrointestinal tract. Schwannomas in the porta hepatis are extremely rare, with only 15 cases described in the literature to date. A 22-year-old female patient presented with colicky upper abdominal pain lasting 3 months. Magnetic resonance imaging of the abdominal cavity revealed a tumor in the porta hepatis. The patient was qualified for laparoscopy. The tumor was totally excised laparoscopically under guidance of laparoscopic ultrasound without intra- or postoperative complications. Postoperative histopathological examination confirmed the porta hepatic schwannoma. The patient recovered uneventfully with very good cosmetic results. In the follow-up period of 5 months we have not observed any abdominal or general health problems. The present case is the first report in the world of laparoscopic ultrasound guided laparoscopic excision of a porta hepatic schwannoma.

“…Laparoscopic cholecystectomy can be performed for acute, gangrenous, and/or perforated cholecystitis. Being feasible and safe, laparoscopic cholecystectomy is also cheaper than open procedures [ 10 ], but conversion may be necessary in case of difficulty such as an obscure anatomy [ 8 ]. Especially, as type II perforations are frequently related to subacute cholecystitis, they can be mistaken for frozen Calot’s triangle.…”

Section: Discussionmentioning

confidence: 99%

Single center experience in laparoscopic treatment of gallbladder perforation.

Şahbaz¹,

Peker²,

Kabuli³

et al. 2017

IntroductionGallbladder perforation (GBP) is a rare disease with potential mortality. Previous series have reported an incidence of approximately 2–11% and it still continues to be a significant problem for surgeons.AimTo present our clinical experience with gallbladder perforation.Material and methodsThe records of 2754 patients who received surgical treatment for cholelithiasis between 2010 and 2016 were reviewed retrospectively. One hundred thirty-three patients had gallbladder perforation. Age, gender, time from the onset of symptoms, diagnostic procedures, surgical treatment, morbidity and mortality rates were evaluated.Results15.78% of patients had a body mass index > 35. 6.76% had chronic obstructive pulmonary disease, 6.76% had cardiac disease, 10.52% had diabetes and 4.51% had sepsis. American Society of Anesthesiology scores were I in 54.13%, II in 35.33%, III in 6.01% and IV in 4.51% of the patients. 27.81% of patients were diagnosed during surgery. The perforation site was the gallbladder fundus in 69.17%, body in 17.30%, Hartman’s pouch in 10.53% and cystic duct in 3% of patients. Treatment modalities were laparoscopic cholecystectomy in 82.71%, open cholecystectomy in 3%, percutaneous drainage catheters + laparoscopic cholecystectomy in 3%, laparoscopic cholecystectomy + fistula repair in 10.53% and open cholecystectomy + fistula repair in 0.75% of patients. Mean length of hospital stay was 1.69 days. Mortality and morbidity rates were 8.27% and 10.52%, respectively. Histopathology results were acute cholecystitis in 69.93%, chronic cholecystitis in 20.30% and acute exacerbation over chronic cholecystitis in 9.77% of patients.ConclusionsAppropriate classification and management of perforated cholecystitis is essential. Laparoscopic cholecystectomy is a safe and feasible method to decrease morbidity in gallbladder perforations.