scholarly journals Optimal surgical technique, use of intra-operative cholangiography (IOC), and management of acute gallbladder disease: the results of a nation-wide survey in the UK and Ireland

2010 ◽  
Vol 92 (4) ◽  
pp. 302-306 ◽  
Author(s):  
P Sanjay ◽  
C Kulli ◽  
FM Polignano ◽  
IS Tait
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Teaching Hospital ◽  
Gallbladder Disease ◽  
Critical View ◽  
Operative Cholangiography ◽  
Critical View Of Safety ◽  
Calot’S Triangle ◽  
Laparoscopic Cbd Exploration ◽  
Cbd Exploration

INTRODUCTION There is debate on optimal techniques that reduce bile duct injury during laparoscopic cholecystectomy (LC). A national survey of Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) members was carried out to determine current surgical practice for gallstones, including the use of intra-operative cholangiography (IOC) or critical view of safety to reduce the risk of bile duct injury. SUBJECTS AND METHODS An anonymous postal survey was sent to all 417 AUGIS members. Data on grade of surgeon, place of work (district general hospital, teaching), subspecialty, number LC per year, use of IOC, critical view of safety, and management of stones detected during surgery were collated. RESULTS There was a 36% (152/417) response – 134 (88%) from consultant surgeons (36, HPB; 106,OG; 64, DGH; 88, teaching hospital). Of these, 38% performed > 100 LC per year, 36% 50–100 LC per year, and 22% 25–50 LC per year. IOC was routine for 24%; and selective for 72%. Critical view of Calot's triangle was advocated by 82%. Overall, 55% first clip and divide the cystic artery, whereas 41% first clip and divide the cystic duct. Some 39% recommend IOC and 23% pre-oper-ative MRCP if dilated common bile duct (CBD) is noted on pre-operative ultrasound. When bile duct stones are identified on IOC, 61% perform laparoscopic CBD exploration (LCBDE), 25% advise postoperative ERCP, and 13% perform either LCBDE or ERCP. Overall, 88% (n = 134) recommend index cholecystectomy for acute pathology, and this is more likely in a teaching hospital setting (P= 0.003). Laparoscopic CBD exploration was more likely to be performed in university hospitals (P< 0.05). CONCLUSIONS A wide dissection of Calot's triangle to provide a critical view of safety is the technique most commonly recommended by AUGIS surgeons (83%) to minimise risk of bile duct injury, in contrast to 24% that recommend routine IOC. The majority (88%) of AUGIS surgeons advise index admission cholecystectomy for acute gallbladder disease.

The rationale of critical view of safety in laparoscopic cholecystectomyA study done in Al Diwanyia teaching hospital

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Muayad Alkhafaji ◽  
Ahmed Alsagban ◽  
Rawya Reyadh Abbood
Keyword(s):  
Bile Duct ◽  
Acute Cholecystitis ◽  
Teaching Hospital ◽  
Cystic Duct ◽  
Operating Time ◽  
Chronic Cholecystitis ◽  
Critical View ◽  
Safe Method ◽  
Critical View Of Safety ◽  
Calot’S Triangle

Laparoscopic cholecystectomy (LC) has become the standard method for the removal of a diseased gallbladder. The technique most commonly employed is the infundibular approach which entails dissecting the gallbladder (GB) from its neck upward, after dissecting the cystic artery and cystic duct using laser or electrocautery. Common bile duct (CBD) injury is one of the most serious complications of LC. misidentification of the bile duct during dissection of the Calot's triangle can lead to such injuries. The critical view of safety (CVS) has been recently discussed in controlled study, it is characterized by dissection of the upper part of the Calot's space, which does not usually contain arterial or biliary anomalies so it is ideal for a safe dissection even in less experienced hands2. This study was amid to introduce a safe method for dissection of the GB away from CBD which forms one boarder in the Calot's triangle. This Prospective clinical analysis of 1000 cases of LC was utilizing the CVS technique over a period from January 2014 to January 2017 was conducted at Al-Diwanyia Teaching Hospital Laparscopic Center.The diagnosis of acute cholecystitis, chronic cholecystitis and cholilithiasis was established with history, physical examination, and ultrasound examination. The patients were categorized for sex, age, operating time and post operative There were 270 (27%) LC for (acute cholecystitis) and 730 (73%) LC for (chronic cholecystitis and cholilithiasis). There were minor significant complications when compared with CBD injuries complications, with short operating time (mean time for operation in our study35.9 minutes). Critical view of safety (CVS) seems to be a safe method of dissection that clearly demonstrating the cystic duct and help to reduce the bile duct injuries.  

scholarly journals Bile Duct Injury in Laparoscopic Cholecystectomy

2021 ◽  
Vol 15 (9) ◽  
pp. 2296-2297
Author(s):  
Mariam Fatima ◽  
Naeem Ghaffar ◽  
Muhammad Shahid Hussain
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Gall Stone ◽  
Stone Disease ◽  
Critical View ◽  
Critical View Of Safety ◽  
Calot’S Triangle ◽  
Gall Stone Disease

Background: Laparoscopic cholecystectomy is commonly performed surgical procedure for symptomatic gall stone disease due to its better cosmetic results and shorter hospital stay; however, its safety in some cases is still questionable5. Methods: A retrospective, observational study was done in surgical unit 1, Sir Ganga Ram hospital, Lahore, from January 2017 to December 2019. Results: There were 209 cases whose surgical notes, hospital record and follow up notes were studied. Among these, 21 cases were converted to open. There was no injury of bile duct in any case. Conclusion: Experience of surgeon, careful dissection at calot’s triangle, use of critical view of safety and timely decision for conversion to open were factors participating insafe surgery. Keywords: Laparoscopic Cholecystectomy, Bile duct injury, critical view of safety

scholarly journals Rouviere\'s Sulcus and Critical View of Safety: A Guide to prevent Bile Duct Injury during Laparoscopic Cholecystectomy

2018 ◽  
Vol 11 (1) ◽  
pp. 25-28
Author(s):  
Tanweer Karim ◽  
Subhajeet Dey ◽  
Atul Jain ◽  
Malwinder Singh ◽  
Nabal Mishra ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Critical View ◽  
Critical View Of Safety

scholarly journals P-BN17 Laparoscopic subtotal cholecystectomy is a safe and effective treatment for gallstone disease

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Emily Leivers ◽  
Zaher Toumi
Keyword(s):  
Hospital Admissions ◽  
Gallbladder Disease ◽  
Gallstone Disease ◽  
Bile Leak ◽  
Biliary Colic ◽  
Critical View ◽  
Critical View Of Safety ◽  
Subtotal Cholecystectomy ◽  
Calot’S Triangle ◽  
Gallbladder Surgery

Abstract Background Laparoscopic cholecystectomy is the gold standard treatment of gallstones in fit patients with symptomatic gallbladder disease. If the critical view of safety cannot be achieved intra-operatively, there are few options, one of which is laparoscopic subtotal cholecystectomy. This study aims to ascertain the outcomes of subtotal cholecystectomy. Methods Retrospective review of all patients who underwent laparoscopic subtotal cholecystectomy by a single surgeon over a 5 year period. Results 37 consecutive patients who underwent subtotal cholecystectomy were included in this study; seventeen of which were males (49%); the median age was 69, and 18 were emergencies (49%).The most common reasons for conversion to laparoscopic subtotal cholecystectomy were adhesions (57%) and fibrotic Calot’s triangle (22%). One patient required ERCP and biliary stenting for ongoing bile leak and another returned to theatre for post operative bleeding during index admission. 6 patients (16%) required further hospital admissions for gallstone disease (1 for biliary colic, two for cholecystitis and three for CBD stones). 3 patients required ERCP. None required further gallbladder surgery. Conclusions Laparoscopic subtotal cholecystectomy is a safe and effective alternative to total cholecystectomy when the critical view of safety cannot be achieved. In our experience, only a small proportion of patients have recurrent biliary problems. 

Operative Strategy Can Reduce the Incidence of Major Bile Duct Injury in Laparoscopic Cholecystectomy

2008 ◽  
Vol 74 (10) ◽  
pp. 985-987 ◽  
Author(s):  
Sara Yegiyants ◽  
J. Craig Collins
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Published Data ◽  
Single Institution ◽  
Operative Strategy ◽  
Critical View ◽  
Critical View Of Safety ◽  
Order Of Magnitude ◽  
Magnitude Improvement

Major bile duct injury (BDI) rates remain in the range of 0.3 to 0.5 per cent for laparoscopic cholecystectomy (LC). The dominant surgical technique worldwide continues to be the “infundibular” technique of dissection that was popularized in the early 1990s. Proponents of the “critical view of safety” (CV) technique have suggested that most of these injuries are avoidable. The objective of our study was to determine whether routine use of the CV technique reduced the observed/expected single-institution rate of major BDI over a 5-year period in a teaching hospital. All patients (n = 3042) who underwent LC for any indication at one institution over a 60-month period were identified by database search. Major BDI was identified by Common Procedural Terminology codes indicating operative repair and confirmed by review of medical records. One patient sustained a transection–excision of the common duct requiring hepaticoduodenostomy. Based on published data, the observed BDI rate was one in nine to one in 15 of the expected rate. This represents an order-of-magnitude improvement in the safety of LC at a single institution where the majority of cases were performed by residents. We suggest that the “critical view” technique should be widely adopted.

scholarly journals THE CRITICAL VIEW OF SAFETY PREVENTS THE APPEARANCE OF BILIARY INJURIES? ANALYSIS OF A SURVEY

2018 ◽  
Vol 31 (2) ◽  
Author(s):  
Mariano Eduardo GIMÉNEZ ◽  
Eduardo Javier HOUGHTON ◽  
Manuel E. ZELEDÓN ◽  
Mariano PALERMO ◽  
Pablo ACQUAFRESCA ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Online Survey ◽  
Critical View ◽  
Critical View Of Safety ◽  
Career Length ◽  
Common Practices

ABSTRACT Background: The risk of bile duct injury (BDI) during cholecystectomy remains a concern, despite efforts proposed for increasing safety. The Critical View of Safety (CVS) has been adopted promoting to reduce its risk. Aim: To perform a survey to assess the awareness of the CVS, estimating the proportion of surgeons that correctly identified its elements and its relationship with BDI. Methods: An anonymous online survey was sent to 2096 surgeons inquiring on their common practices during cholecystectomy and their knowledge of the CVS. Results: A total of 446 surgeons responded the survey (21%). The percentage of surgeons that correctly identified the elements of CVS was 21.8% and 24.8% among surgeons claiming to know the CVS. The percentage of surgeons that reported BDI was higher among those that incorrectly identified the elements of the CVS (p=0.03). In the multivariate analysis, career length was the most significant factor related to BDI (p=0.002). Conclusions: The percentage of surgeons that correctly identified the Critical View of Safety was low, even among those who claimed to know the CVS. The percentage of surgeons that reported BDI was higher among those that incorrectly identified the elements of the CVS.

Bile Duct Injury in Laparoscopic Cholecystectomy

2017 ◽  
Author(s):  
Justin Steggerda ◽  
Eric Simms ◽  
Miguel Burch
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Clinical Case ◽  
Technical Aspects ◽  
Critical View ◽  
Critical View Of Safety ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of a landmark study in performance of laparoscopic cholecystectomy. Can we improve safety and reduce the risk of bile duct injury during laparoscopic cholecystectomy? Starting with that question, it provides information including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter reviews identified risk factors and describes technical aspects the authors identified to increase safety, notably defining the critical view of safety. The chapter also provides a brief critique, review of other notable studies, and concludes with a relevant clinical case regarding possible treatment of a patient with ERCP.

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