Fundus first as the standard technique for laparoscopic cholecystectomy

AbstractIn previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation. The feasibility and safety profile when introducing FF as the standard technique were aimed in this study. Between 2004–2014, 29 surgeons performed 1425 LC with FF and 320 with a conventional technique. During the first year 56% were with FF and 98% during the last four years. More females, ultrasonic shears, urgent operations, daycare operations and a shorter operation time were found with FF. 63 (3.6%) complications occurred: 10 (0.6%) bleedings, 33 (1.9%) infections and 12 (0.7%) bile leakages. Leakage from cystic duct occurred in 4/112 (3.6%) when closed with ultrasonic shears and in 4/1633 (0.2%) with clips (p 0.008). A common bile duct lesion occurred in 1/1425 (0.07%) with FF and in 3/320 (0.9%) with the conventional approach (p 0.003). In a multivariate regression model, the conventional technique was a risk factor for bile duct injury with an odds ratio of 20.8 (95% CI 1.6–259.2). In conclusion FF was effectively established as the standard procedure and associated with lower rates of bile duct injuries. Clipless closure of the cystic duct increased the rate of leakage.

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Bile Duct Injuries Following Laparoscopic Cholecystectomy

Journal of Science Foundation ◽

10.3329/jsf.v15i1.34778 ◽

2018 ◽

Vol 15 (1) ◽

pp. 14-19

Author(s):

Mohammad Ibrahim Khalil ◽

Haridas Saha ◽

Azmal Kader Chowdhury ◽

Imarat Hossain ◽

AZM Mostaque Hossain

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Bile Duct Injury ◽

Open Cholecystectomy ◽

Standard Procedure ◽

Gall Stone ◽

Common Bile Duct Injury ◽

Medical College ◽

Bile Duct Injuries ◽

Case Files

Background: Laparoscopic cholecystectomy (LC) is the gold standard procedure for the gall stone diseases.Objective: This study aimed to assess the outcome of laparoscopic cholecystectomy (LC) by determining the frequency of complications especially of bile duct injuries.Methodology: This retrospective study was conducted in the Department of surgery at Dhaka Medical College and Hospital, Dhaka, Bangladesh. The case files of all patients undergoing laparoscopic cholecystectomy (LC) from the year of 2013 to 2015 were retrospectively analyzed. The data were collected according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose resections had to be converted from laparoscopic to open surgery.Results: During the three years a total number of 336 patients were underwent LC for chronic cholecystitis (CC) of which 22(6.5%) developed complications. Among those who developed complications, two patients had major bile duct injuries (0.4%); other 43(12.8%) patients had planned laparoscopic operations converted to open cholecystectomy intra-operatively. None of the patients in this study died as a result of LC.Conclusion: The two patients who had severe common bile duct injury in this study had major anatomical anomalies that were only recognized during surgery.Journal of Science Foundation 2017;15(1):14-19

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The “critical view of safety (CVS)” cannot be applied—What to do? Strategies to avoid bile duct injuries

European Surgery ◽

10.1007/s10353-020-00660-1 ◽

2020 ◽

Author(s):

Hans-Jörg Mischinger ◽

Doris Wagner ◽

Peter Kornprat ◽

Heinz Bacher ◽

Georg Werkgartner

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Vascular System ◽

Open Cholecystectomy ◽

Standard Procedure ◽

Underlying Disease ◽

Behavioral Measures ◽

Anatomical Structures ◽

Critical View Of Safety ◽

Bile Duct Injuries

Summary Laparoscopic cholecystectomy has become the standard procedure worldwide since the early 1990s for those patients whose gallbladder has to be removed as part of their underlying disease (NIH Consensus Statement 1992). The most common complication is iatrogenic bile duct injury, which has not improved significantly since the introduction of open laparoscopic cholecystectomy as compared with open cholecystectomy. The intraoperative injuries are mostly the result of a misinterpretation of anatomical structures due to severe inflammation or topographical variations. In order to minimize this risk, a number of improved operative techniques and behavioral measures have been formulated. Here, we present methodological and operative possibilities as well as techniques that in unclear situations can help to minimize the risk of intraoperative injuries of the biliary tract and the accompanying vascular system.

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Mini Cholecystectomy: a comparison with Laparoscopic Cholecystectomy

Annals of King Edward Medical University ◽

10.21649/akemu.v11i4.1059 ◽

2016 ◽

Vol 11 (4) ◽

Author(s):

Ashfaq Ahmad ◽

Hassan Muhammad Khan ◽

Samina Gulshan ◽

Tahir Ahmad Shah

Keyword(s):

Laparoscopic Cholecystectomy ◽

Standard Procedure ◽

Operation Time ◽

Laparoscopic Group ◽

Laparoscopic Technique ◽

Bile Duct Injuries ◽

Total Hospital Stay ◽

Significant Difference ◽

Symptomatic Gallstones ◽

Mini Laparotomy

Laparoscopic cholecystectomy is the gold standard procedure for symptomatic gallstones but at a higher price. Recently a few studies comparing mini cholecystectomy to laparoscopic cholecystectomy have shown that mini cholecystectomy has comparable results to laparoscopic cholecystectomy at an affordable price. We compared these two techniques over a period of two years.224 patients were studied, 122 had laparoscopic and 102 had mini laparotomy cholecystectomies. Results showed that operation time and theatre cost were low in mini laparotomy cholecystectomies but these patients required more post operative analgesics. There was no significant difference in total hospital stay and resumption to routine activities. Total cost to hospital and patient was also similar for these two techniques. There were two common bile duct injuries in laparoscopic group and none in mini cholecystectomies and there was no mortality in either group. We conclude that results of mini laparotomy cholecystectomy are very much simi lar to laparoscopic cholecystectomy and it can be used as an alternative to laparoscopic technique.

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Iatrogenic Bile Duct Injuries: An Overview and A Review of Literature

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0041-1730123 ◽

2021 ◽

Vol 07 (01) ◽

pp. 037-043

Author(s):

Vinoth M. ◽

Abhijit Joshi

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Bile Duct Injury ◽

Surgical Procedures ◽

Surgical Repair ◽

Review Of Literature ◽

Bile Duct Injuries ◽

Iatrogenic Bile Duct Injury

Abstract Laparoscopic cholecystectomy (LC) is one of the most frequently performed surgical procedures worldwide. Iatrogenic bile duct injury (IBDI) is a serious complication of LC and has an incidence of 0.3 to 0.7%. Since it is associated with a significant and potentially lifelong morbidity as well as mortality, diagnosing IBDI as early as possible is of paramount importance. Management of bile duct injuries and prognosis of their surgical repair depend on the timing of its recognition, type and the extent of the injury. In this paper, we present a case of IBDI and attempt to discuss all its dimensions.

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Erratum to: Age and Obesity are Independent Predictors of Bile Duct Injuries in Patients Undergoing Laparoscopic Cholecystectomy

World Journal of Surgery ◽

10.1007/s00268-015-3022-8 ◽

2015 ◽

Vol 39 (7) ◽

pp. 1809-1809 ◽

Cited By ~ 1

Author(s):

Hassan Aziz ◽

Viraj Pandit ◽

Bellal Joseph ◽

Tun Jie ◽

Evan Ong

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Bile Duct Injuries

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The Prevention of Laparoscopic Bile Duct Injuries: An Analysis of 300 Cases of from a Human Factors and Cognitive Psychology Perspective

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193120705101103 ◽

2007 ◽

Vol 51 (11) ◽

pp. 617-620 ◽

Cited By ~ 1

Author(s):

Lygia Stewart ◽

Lawrence W. Way

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Human Factors ◽

Bile Duct Injury ◽

Human Error ◽

Perceptual Illusion ◽

Bile Duct Injuries ◽

Psychology Perspective ◽

Cause Of Error ◽

Key Steps

Application of human factors concepts to high-risk activities has facilitated reduction in human error. With introduction of laparoscopic cholecystectomy, the incidence of bile duct injury increased. Seeking ideas for prevention, we analyzed 300 laparoscopic bile duct injuries within the framework of human error analysis. The primary cause of error (97%) was a visual perceptual illusion. The laparoscopic environment contributed to 75% of injuries, poor visibility 22%. Most injuries involved deliberate major bile duct transection due to misperception of the anatomy. This illusion was so compelling that the surgeon usually did not recognize it. Even when irregular cues were detected, improper rules were employed, eliminating feedback. Since the complication-causing error occurred at few key steps during laparoscopic cholecystectomy; we instituted focused training to heighten vigilance, and have formulated specific rules to decrease the incidence of bile duct injury. In addition, factors in the laparoscopic environment contributing to this illusion are discussed.

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