Initial experience with endoscopic ultrasound-guided gallbladder drainage.

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

“…Therefore, especially in the presence of severe pericholecystic inflammation making it difficult to identify anatomical structures, it is recommended to refrain from immediate cholecystectomy. Beside conservative treatment, the minimally invasive methods of external bile drainage seem to be of special importance [26].…”

Section: Discussionmentioning

confidence: 99%

Excision of a part of the bile duct as an iatrogenic injury typical for laparoscopic cholecystectomy - characteristics, treatment and long-term results, based on own material.

Durowicz

Kozicki

Ciesielski

et al. 2019

Introduction: Cholecystectomy is associated with the risk of bile duct injury (BDI). The nature of the injury in laparoscopic cholecystectomy (LC) cases seems to be more serious. Aim: We present an analysis of long-term results of the treatment of patients who underwent operations at our department due to iatrogenic excision of a part of the bile duct (EPBD). Material and methods: Out of all 120 patients treated for BDI in our department we selected a group of 40 with EPBD. In all cases the corrective operation was hepaticojejunostomy. The median follow-up time was 157 (56-249) months. We evaluated risk factors for EPBD during LC compared to open cholecystectomy (OC). Results: Among bile duct injuries referred to our centre, EPBD occurred more frequently during LC (46.7%) compared to OC (11%), p < 0.001. Injuries located in the hepatic hilum occurred more often in the case of LC (68.6%) than OC (20%), p = 0.056. We did not find a difference in the frequency of EPBD between LC and OC groups depending on the presence of acute or chronic cholecystitis. The narrow common hepatic duct was reported more frequently in the LC (68.6%) vs. OC (20%) group, p = 0.056. Satisfactory long-term reconstructive treatment results were observed in 36 (90%) of 40 patients. Conclusions: Excision of a part of the bile duct occurs more often during LC than OC. It is often located in the hepatic hilum. Presence of a narrow common hepatic duct is a risk factor for EPBD during LC. Large diameter hepaticojejunostomy is a reconstructive procedure that promises good long-term results.

“…The treatment of cholecystolithiasis ranges from conservative treatment to resection surgery [15][16][17][18]. Operative treatment still remains the first-line choice of treatment for cholecystolithiasis [19].…”

Section: Discussionmentioning

confidence: 99%

Reconsideration of indications for choledochoscopic gallbladder-preserving surgery and preventive measures for postoperative recurrence of gallstones.

Wang

et al. 2019

Introduction: The recurrence of cholecystolithiasis after choledochoscopic gallbladder-preserving surgery is a major problem. It is unclear whether the recurrence of cholecystolithiasis is due to the limitations of the operation itself or to the selection of inappropriate candidates. Aim: To analyze the recurrence of cholecystolithiasis after choledochoscopic gallbladder-preserving surgery and to provide guidance for the treatment of cholecystolithiasis by choledochoscopic gallbladder-preserving surgery. Material and methods: A total of 145 patients who had undergone choledochoscopic gallbladder-preserving surgery were studied from January 2012 to January 2018. The recurrence rate, recurrence time, and risk factors were evaluated. Results: Of these 145 patients, 14 (9.66%) experienced recurrence with a mean follow-up time of 39.72 ±24.44 months. The mean time to recurrence was 30.07 ±21.21 months. Univariate analysis showed that pregnancy history (p = 0.008), the uniformity of gallstones (p = 0.002), preoperative inflammation (p = 0.022), postoperative oral drugs (p = 0.022) and the regularity of diet (p = 0.001) were significantly related to recurrence. The uniformity of gallstones (odds ratio (OR) = 0.079; 95% confidence interval (CI): 0.010-0.590; p = 0.013) and the regularity of diet (OR = 0.074; 95% CI: 0.010-0.528; p = 0.009) were independent prognostic factors for recurrence according to multivariate analysis. Conclusions: Nonuniform gallstones combined with an irregular diet are significant risk factors that predict cholecystolithiasis recurrence.