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

Atta, Hussein M.; Mohamed, Ashraf A; Sewefy, Alaa M.; Abdel-Fatah, Abdel-Fatah S.; Mohammed, Mohammed M.; Atiya, Ahmed M.

doi:10.1155/2017/6467814

Cited by 23 publications

(22 citation statements)

References 23 publications

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“…In contrast, the absence of surgical trainees characterizes hospitals with high adjusted cholecystectomy rates. This contrast may be a reason for superior outcomes in hospitals with high adjusted cholecystectomy rates, although previous literature rejects this explanation [25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Hospital Variation in Cholecystectomies in The Netherlands: A Nationwide Observational Study

et al. 2020

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Background: Practice variation generally raises concerns about the quality of care. This study determined the longitudinal degree of hospital variation in proportion of patients with gallstone disease undergoing cholecystectomy, while adjusted for case-mix, and the effect on clinical outcomes. Methods: A nationwide, longitudinal, database study was performed in all hospitals in the Netherlands in 2013-2015. Patients with gallstone disease were collected from the diagnosis-related group database. Hospital variation in casemix-adjusted cholecystectomy rates was calculated per year. Clinical outcomes after cholecystectomy were compared between hospitals in the lowest/highest 20th percentile of the distribution of adjusted cholecystectomy rates in all 3 subsequent years. Results: In total, 96,673 patients with gallstones were included. The cholecystectomy rate was 73.6%. In 2013-2015, the case-mix-adjusted performance of cholecystectomies was in hospitals with high rates 1.5-1.6 times higher than in hospitals with low rates. Hospitals with a high adjusted cholecystectomy rate had a higher laparoscopy rate, shorter time to surgery, and less emergency department visits after a cholecystectomy compared to hospitals with a low-adjusted cholecystectomy rate. Conclusion: Hospital variation in cholecystectomies in the Netherlands is modest, cholecystectomy rates varies by <2-fold, and variation is stable over time. Cholecystectomies in hospitals with high adjusted cholecystectomy rates are associated with improved outcomes.

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Section: Discussionmentioning

confidence: 99%

Hospital Variation in Cholecystectomies in The Netherlands: A Nationwide Observational Study

et al. 2020

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“…In another study that compared the outcome of LC done by resident trainees and experienced surgeons, it was deduced that trainees could perform difficult LCs under careful supervision and it did not increase the risk of complications; however, trainees took a long time to complete the procedure. They reported a conversion rate of only 1.7% in their study [19]. In comparison, Indian study reported high complication rate (14%), bile leakage (35.3%) and subhepatic abscess (26.5%) as common complications as compared to hemorrhage (11.8%) [20] reported in most of the literature [15,16].…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Complications Associated with Laparoscopic Cholecystectomy for Symptomatic Gallstones

Amreek

Hussain

Mnagi

et al. 2019

Cureus

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IntroductionGallstones are the major cause of global morbidity. Laparoscopic approach has well-established advantages as compared to the conventional open procedure. It promises better recovery, lower morbidity, and lower postoperative pain, shortens the duration of hospital stay, and has a lower mortality rate. The aim of this study is to assess the frequency of complications in laparoscopic cholecystectomies indicated for symptomatic gallstones and also evaluate the rate of conversion.MethodsIn this retrospective analysis, all records of laparoscopic cholecystectomy, in patients of age ≥18 years, for symptomatic gallstones, from January 2015 till December 2018 in one of the largest public tertiary care hospitals in Pakistan were included.ResultsThe rate of complications associated with laparoscopic cholecystectomy was 6.8%. Older age, obesity, and multiple pre-operative risk factors were associated with complications. The most common intra-operative complication was hemorrhage (1.3%) and most common postoperative complication was surgical site infection (2.7%). Our conversion rate was 3.6%. Both intra-operative and postoperative complications were more common in procedures which were converted to open.ConclusionThe rate of complication and conversion to open in laparoscopic cholecystectomy is not very high. Older age, obesity, and multi-morbidity was associated with complications. Complicated procedures were more commonly needed to be converted to open.

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“…It has been argued that difficult cholecystectomy may be due to adhesion and bleeding, abnormal biliary anatomy and fibrosis, or obesity (2,19). In the literature, it is reported that the presence of adhesion in the Calot's triangle increases the risk for difficult cholecystectomy at least threefold (19,20). It is believed that the most objective criterion for determining the degree of difficulty of the Calot's triangle dissection was the time taken to complete the procedure.…”

Section: Bleeding 6 24mentioning

confidence: 99%

Effect of Duration of Calot’s Triangle Dissection on the Definition of Difficult Cholecystectomy

Köse¹

2019

JAREM

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The aim of the study was to investigate the effect of Calot's triangle dissection time on convert to open elective laparoscopic cholecystectomy to open cholecystectomy, prolonged operation time (≥120min), and prediction of the difficulty associated with complications development. Methods: A retrospective analysis was performed in patients who were diagnosed with cholelithiasis and planned for laparoscopic cholecystectomy between March 2015 and November 2016. Demographic and clinical data (previous operation history, acute cholecystitis, a history of cholangitis and pancreatitis, history of endoscopic retrograde cholangiopancreatography, and Calot's dissection duration and total operation time) were collected from 300 patients involved in the study. A total operation time lasting 120 minutes and longer, convert to open cholecystectomy from the laparoscopic technique, and intraoperative complication related with cholecystectomy (biliary injury, uncontrolled bleeding) were chosen as difficult cholecystectomy and named as Group 1. All other patients out of these findings were put in as Group 2. The factors that caused difficult cholecystectomy were analyzed statistically. Results: The mean age of patients was 50.6±14 years; 203 (68%) were female and 97 (32%) were male. A total of 25 patients (8%) were considered to have difficult cholecystectomy (Group 1). There was a statistically significant difference between the groups in terms of gender (p=0.002), acute cholecystitis (p=0.009), and acute cholangitis history (p=0.009). Calot's dissection duration and operation time were significantly longer in Group 1 (p=0.0001 and p=0.0001, respectively). Calot's dissection optimum time was defined as 15 minutes (72% sensitivity and 84.7% specificity) in patients who were considered to have difficult cholecystectomy. There was a significant correlation between the duration of Calot's dissection time that was longer than 15 minutes and the occurrence of difficult cholecystectomy (p=0.0001). Conclusion: The failure to complete Calot's triangle within a specified time during elective cholecystectomy procedures can be considered as a difficult cholecystectomy criterion.

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

Cited by 23 publications

References 23 publications

Hospital Variation in Cholecystectomies in The Netherlands: A Nationwide Observational Study

Hospital Variation in Cholecystectomies in The Netherlands: A Nationwide Observational Study

Retrospective Analysis of Complications Associated with Laparoscopic Cholecystectomy for Symptomatic Gallstones

Effect of Duration of Calot’s Triangle Dissection on the Definition of Difficult Cholecystectomy

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