Surgeon Knowledge, Behavior, and Opinions Regarding Intraoperative Cholangiography

Massarweh, Nader N.; Devlin, Allison; Elrod, Jo Ann Broeckel; Symons, Rebecca; Flum, David R.

doi:10.1016/j.jamcollsurg.2008.08.011

Cited by 56 publications

(46 citation statements)

References 21 publications

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“…However, when selectively and judiciously performed, it presented values equal to or less than 1% of positivity 19,6 . It was noted in this study a positivity of 1% for the perioperative examination, which is consistent with the values found in the literature 4,5,7,12,10,17,19 . It can be inferred, given this 1% choledocholithiasis positivity rate, that only 0.15% of patients would have postoperative complications based on the study of Matthew et al…”

Section: Results Results Results Resultssupporting

confidence: 93%

“…In this study it was on average 13.54 min, which corresponds to 35% of the total surgical time of laparoscopic cholecystectomy, increasing the duration of anesthesia and total time of the procedure 20 , plus the cost of contrast, catheter, syringe and radiological films [5][6][7][8]10,12,17,19,[21][22][23] . Some reports include age over 70 years as a risk for cholelithiasis and choledocholithiasis 24,25 .…”

Section: Results Results Results Resultsmentioning

confidence: 99%

“…Ludwig et al, in a German study, found that only 6% of institutions use perioperative cholangiography (POC) systematically during LCs, 49.5% of them use it selectively and 43% of institutions do not perform any diagnostic procedure at the time of LC 3 . Although the systematic use of POC is still defended by a considerable number of surgeons who choose for the perioperative instrumentation of the biliary duct, the largest part argues that the POC, conducted in a systematic way, has not been cost-effective 4 , increasing operative time and the number of false-positive diagnoses, overestimating choledocholitiasis 5,6 , and especially increasing the proportion of patients undergoing unnecessary instrumentation of the biliary tract with the inherent risks of morbidity and mortality 5,7 . Matthew et al, in a meta-analysis, reported 4,209 preoperatively POCs performed in unsuspected patients for gallstones in the bile duct.…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

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Avaliação da positividade da colangiografia peroperatória em pacientes submetidos à colecistectomia laparoscópica eletiva

Crema

Camara

Pastore

et al. 2010

Rev. Col. Bras. Cir.

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Objective: To evaluate the positivity of cholangiography in patients without formal indication of this exam undergoing elective cholecystectomy. Methods: We included, in the study, 100 patients whose clinical, laboratory and imaging not older than 10 days before the operation showed no change and therefore kept us unsuspicious of choledocholithiasis. The cholangiographies were analyzed and examined by the surgical team, the radiologist and the authors. The reports were compared and correlated with patients' previous clinical and laboratory findings. Results: The incidence of preoperatively unsuspected choledocholithiasis was only one case (1%). Conclusion: The use of selective cholangiography is safe and should be used in the treatment of calculous cholecystitis.

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Section: Results Results Results Resultssupporting

confidence: 93%

Section: Results Results Results Resultsmentioning

confidence: 99%

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

See 1 more Smart Citation

Avaliação da positividade da colangiografia peroperatória em pacientes submetidos à colecistectomia laparoscópica eletiva

Crema

Camara

Pastore

et al. 2010

Rev. Col. Bras. Cir.

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“…In contrast, the initial repair was successful in 84 % of patients when IOC data was complete. This required level of competence, in technique and interpretation, might be linked to why surgeons performing IOC routinely have more favorable opinions about its usefulness and have a corresponding lower incidence of BDI [2,66].…”

Section: Role Of Intraoperative Cholangiogram (Ioc): a Literature Ovementioning

confidence: 99%

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

et al. 2012

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Laparoscopic cholecystectomy is now one of the most frequently performed abdominal surgical procedures in the world. The most common major complication is bile duct injury, which can have catastrophic repercussions for patients and it has been suggested that intraoperative cholangiography may reduce the rate of bile duct injury. Whether this procedure should be performed routinely is still an active subject of debate. We discuss the available evidence and likely implications for the future.

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“…Only 20% of all respondents considered intraoperative cholangiography (IOC) to be important in our survey. The ratio of surgeons that routinely perform IOC is reportedly highly variable, ranging from <5% in the Netherlands, 25% in the USA and UK, to as high as >60% in Australia [32,[39][40][41]. Several authors claimed that IOC cannot prevent BDI and its implication has yet to be defined [42, 43].…”

Section: Discussionmentioning

confidence: 99%

Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul‐de‐sac or the birth pangs of a new technical framework?

Iwashita

Hibi

Ohyama

et al. 2017

J Hepato Biliary Pancreat

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Bile duct injury (BDI) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons' perceptions is scarce. Surgeons from Japan, Korea, Taiwan, and the USA, etc. (n = 614) participated in a questionnaire regarding their BDI experience and near-misses; and perceptions on landmarks, intraoperative findings, and surgical techniques. Respondents voted for a Delphi process and graded each item on a fivepoint scale. The consensus was built when ≥80% of overall responses were 4 or 5. Response rates for the first-and second-round Delphi were 60.6% and 74.9%, respectively. Misidentification of local anatomy accounted for 76.2% of BDI. Final consensus was reached on: (1) Effective retraction of the gallbladder, (2) Always obtaining critical view of safety, and (3) Avoiding excessive use of electrocautery/ clipping as vital procedures; and (4) Calot's triangle area and (5) Critical view of safety as important landmarks. For (6) Impacted gallstone and (7) Severe fibrosis/ scarring in Calot's triangle, bail-out procedures may be indicated. A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BDI.

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Surgeon Knowledge, Behavior, and Opinions Regarding Intraoperative Cholangiography

Cited by 56 publications

References 21 publications

Avaliação da positividade da colangiografia peroperatória em pacientes submetidos à colecistectomia laparoscópica eletiva

Avaliação da positividade da colangiografia peroperatória em pacientes submetidos à colecistectomia laparoscópica eletiva

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul‐de‐sac or the birth pangs of a new technical framework?

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