EP.TH.316Laparoscopic Cholecystectomy in KGH in 2019 - Comparing the Incidence of Complications and Patient Demographics to National Data

Abstract Aims Bile Duct injury is one of the serious complications of Laparoscopic Cholecystectomy and should be avoided. Several recent large studies that have examined Bile Duct Injuries (BDI) during cholecystectomy have found major BDI rates of 0.15-0.36% and an overall biliary complication rate of 1.5% if bile leaks are included. We wished to identify our current complication rate and compare to national data. Methods Retrospective study Data time frame from: 01/01/2019 to 31/10/2019 Type of patients: All patients who underwent elective or emergency laparoscopic cholecystectomy between the above dates Results 312 patients identified and analyzed over the study period. 227 female (72.76%) and 85 male (27.24%) 268 Elective operations (85.9%). 44 Emergency operations (14.10%) Primary outcome Secondary outcomes Conclusions KGH performed 312 cholecystectomy operations between Jan - Oct 2019, putting it in the upper 1/3 of hospitals regarding the number of operations performed per year. (1) The complication rate for the study period was 0.32%. This was one out of the 312 operations. Our incidence of complications is lower than published data reporting complication rates, including bile leaks, of up to 1.5%. There were no bile duct injuries during the study period. The majority (>85%) of cases were performed as elective operations.

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Bile Duct Injuries in Connection With 2500 Laparoscopic Cholecystectomies

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.4.55 ◽

1997 ◽

Vol 4 (2) ◽

pp. 55-60

Author(s):

P. Schmidt ◽

P. Ezer ◽

A. Antal

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Complication Rate ◽

Open Surgery ◽

Biliodigestive Anastomosis ◽

T Tube ◽

The Past ◽

Bile Duct Injuries ◽

Type Of Injury ◽

Methods Of Treatment

Background: Laparoscopic cholecystectomy (LC) is taking the place of an effective and tested procedure in surgery, therefore it must not be inferior to the standard modality in any aspect. Some complications specific to the technique, however, are severe and complication rate seem to be higher than in standard open surgery.Methods: In this paper the authors report their guiding principles in applying LC and methods of treatment, and describe the bile duct injuries of 2500 LCs accomplished during the past 4.5 years.Results: Seventeen ductal injuries occurred in the whole series, which means an overall incidence rate of 0.68%. Data obtained in the last period, however, show a decrease down to 0.14%. Following ductal injuries six ductal strictures became clinically apparent. The various complications of these injuries caused the death of two patients.Conclusions: The great number of intraoperatively undetected injuries, many of them arising not due to technical difficulties, suggest the possibility of an injury caused by electric current. Depending on the type of injury direct suture, T-tube drainage or biliodigestive anastomosis can equally be effective. Long established practice and experience can help reduce the occurrence of complications to the level in standard open surgery.

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Management of major bile duct injuries following laparoscopic and open cholecystectomy - single center experience

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh190206030t ◽

2019 ◽

Vol 147 (7-8) ◽

pp. 422-426

Author(s):

Borislav Toskovic ◽

Dragoljub Bilanovic ◽

Aleksandar Resanovic ◽

Slobodan Todorovic ◽

Davor Mrda ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Bile Duct Injury ◽

Open Cholecystectomy ◽

Injury Incidence ◽

Complication Rates ◽

Open Approach ◽

Single Center ◽

Single Center Experience ◽

Bile Duct Injuries

Introduction/Objective. Bile duct injuries represent a devastating and potentially life-threatening consequence of cholecystectomy. Although most cholecystectomies are currently performed laparoscopically, some complex cases require an open approach. The aim of this report is to present and analyze a single center experience regarding the management of these injuries. Methods. A retrospective study was conducted in a tertiary referral institution. During a 13-year period, we identified a total of 64 patients. Only patients requiring surgical reconstruction to repair bile duct injuries were included in the study. Patients were grouped according to the type of surgical approach, i.e. laparoscopic or open cholecystectomy. Results. Out of 64 patients with bile duct injuries, 38 (59.4%) incurred the injuries during open and 26 (40.6%) during laparoscopic cholecystectomy. No differences between the groups were observed concerning the time of bile duct injury diagnosis, type of injury, incidence of concomitant vascular and bile duct injuries, type of reconstruction procedure or complication rates after the primary intervention. The latency of bile duct injury management was found to differ between the study groups. In the open cholecystectomy group, bile duct injuries were managed significantly later than in the laparoscopic one. Conclusion. The results suggest that bile duct injuries occur with equal frequency after laparoscopic as well as open cholecystectomy. However, injuries are managed later after open than after laparoscopic cholecystectomy. Tertiary centers have satisfactory outcomes of major bile duct injury reconstruction, with low rates of both morbidity and mortality.

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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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