Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study

Hamad, Mostafa A.; Nada, Ahmed; Abdel-Atty, M.; Kawashti, Ahmad S.

doi:10.1007/s00464-011-1780-4

Cited by 50 publications

(24 citation statements)

References 41 publications

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“…In our institution both techniques of intraoperative cholangiography and "critical view of safety" are performed and are responsible for the small rate of bile duct injuries. The value of intraoperative cholangiography has been extensively debated in the literature [15,[19][20][21]. Advantages of conducting routine cholangiography during LC are to retain the ability to perform this measure in cases of questionable anatomy or patency of extrahepatic bile ducts.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic cholecystectomy as a teaching operation: comparison of outcome between residents and attending surgeons in 1,747 patients

Fahrner

Turina

Neuhaus

et al. 2011

Langenbecks Arch Surg

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Purpose Standardized surgical training is increasingly confronted with the public demand for high quality of surgical care in modern teaching hospitals. The aim of this study was to compare the results of laparoscopic cholecystectomy (LC) performed by resident surgeons (RS) and attending surgeons (AS). Methods In this retrospective review of prospectively collected data 1,747 LC were performed in a community hospital between 1999 and 2009. Seven hundred seventy operations were performed by RS. Parameters analysed included the duration of operation and length of hospital stay, intraoperative complications, 30-day morbidity and mortality. Results Duration of operation was 88 (25-245) min for RS vs. 75 (30-190) min by AS (p=0.001). Elective operations were shorter when performed by

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Section: Discussionmentioning

confidence: 99%

Laparoscopic cholecystectomy as a teaching operation: comparison of outcome between residents and attending surgeons in 1,747 patients

Fahrner

Turina

Neuhaus

et al. 2011

Langenbecks Arch Surg

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“…On the other hand, surgeons who adopt the selective implementation of IOC state that only one third of asymptomatic CBD stones need intervention [36]. In the scientific literature there are several articles that have reported a similar series without IOC [37][38][39][40][41].…”

Section: Discussionmentioning

confidence: 99%

Bile Duct Injury during Laparoscopic Cholecystectomy without Intraoperative Cholangiography: A Retrospective Study on 1,100 Selected Patients

Pesce

Portale²,

Minutolo³

et al. 2012

Dig Surg

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Background: Whether to routinely or selectively use intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) has been a controversial issue for many years. Many authors maintain that IOC decreases the rate of biliary complications such as bile duct injuries, biliary leak, and missed common bile duct (CBD) stones. However, in contrast to these claims, many centers have opted to perform LC without IOC. In this retrospective study, the results of a series of 1,100 LCs, all of which involved major biliary complications and which were performed without the use of IOC, were reviewed. Methods: Data from 1,100 selected patients (728 females and 372 males) undergoing LC without the use of IOC from January 2003 to November 2011 were analyzed. One hundred and seventy LCs were performed by young surgeons during the learning curve, and 930 by surgeons with over 10 years of experience. Two techniques were used to create pneumoperitoneum: the Veress technique in 319 cases (29%) and the Hasson technique in the remaining 781 cases (71%). Patients with a suspicion of CBD stones were excluded from the study. Results: Two CBD injuries (0.18%) and three biliary leaks (0.27%) were detected among this group. Thirty-three patients (3%) needed conversion to open cholecystectomy. Missed CBD stones were reported in 4 cases (0.36%). There was no postoperative mortality. Conclusion: LC can be performed safely without the use of IOC and with acceptable low rates of biliary complications. An accurate preoperative evaluation of clinical risk factors, precise operative procedures, and conversion to an open approach in doubtful cases are important measures which must be taken to prevent CBD injury.

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“…Post-op complications were infrequent occurring in only 2 patients (3%), one having post-operative pancreatitis and the other a gallbladder fluid collection. (17) Preoperative liver function tests, (ALT and ALP), were abnormally raised in 22 patients, 9 of these patients were jaundiced. Prior to surgery, all patients underwent a preoperative Ultrasound Scan (USS).…”

Section: Resultsmentioning

confidence: 96%

“…Contemporary adult studies have highlighted the acceptably low rates of biliary complications in LC without resorting to OTC [17]. Hamad et al performed a retrospective analysis of 2714 adult cases, of these cases only 0.18% (n=5) required surgical intervention of bile duct injury.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Routine on Table Cholangiography in Paediatric Cholecystectomy

Gurprashad¹

2017

AJP

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Abstract:The use of on table cholangiogram (OTC) during laparoscopic cholecystectomy (LC) continues to be a debated topic within surgical practice. Current National Institute for Health and Care Excellence (NICE) guidelines do not advocate its routine use in adult patients, and there is scarce evidence for its use in paediatric cases. We aimed to analyse the outcomes of OTC during laparoscopic cholecystectomy to see if the NICE guidance holds true for children. A retrospective case note review was performed with IRB approval of all children who underwent laparoscopic cholecystectomy between February 2005 and November 2014. A total of 65 patients were identified, 41 female (63%) and 24 male (37%). The median age was 12 years (IQR 6). None of the patients underwent OTC during their LC. Instead, pre-operative ultrasound scan (USS) was performed in all cases. From the cohort, 5 patients (13%) showed abnormalities; 3 of which had a dilated common bile duct, and 2 of which had bile duct stones. All 5 patients went on to receive additional imaging, 2 patients underwent a repeat USS both of which were normal on review; 1 patient had an Endoscopic Retrograde Cholangio-Pancreatectography (ERCP), stent and follow-up Magnetic Resonance Cholangio-Pancreatograthy (MRCP) which was normal; 1 patient had an MRCP, ERCP with sphincterotomy and a follow-up USS which was normal; and 1 patient had an ERCP with follow-up USS which was also normal. In line with current NICE guidance for adults, our study indicates that patients with common bile duct (CBD) stones or a dilated CBD can be identified and managed prior to laparoscopic cholecystectomy. This would suggest that there is no requirement for OTC in children. Similar NICE guidance in Paediatrics may be necessary to avoid unnecessary intervention.

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Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study

Abstract: LC can be performed safely without the use of IOC, with acceptable low rates of biliary complications provided that proper detection of patients with silent CBD stones is done and facilities for pre- and postoperative endoscopic retrograde cholangiopancreatography are available.

Cited by 50 publications

References 41 publications

Laparoscopic cholecystectomy as a teaching operation: comparison of outcome between residents and attending surgeons in 1,747 patients

Laparoscopic cholecystectomy as a teaching operation: comparison of outcome between residents and attending surgeons in 1,747 patients

Bile Duct Injury during Laparoscopic Cholecystectomy without Intraoperative Cholangiography: A Retrospective Study on 1,100 Selected Patients

Evaluation of Routine on Table Cholangiography in Paediatric Cholecystectomy

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