Beyond the learning curve: incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era

Halbert, Caitlin; Pagkratis, Spyridon; Yang, Jie; Meng, Ziqi; Altieri, Maria S.; Parikh, Purvi; Pryor, Aurora D.; Talamini, Mark A.; Telem, Dana A.

doi:10.1007/s00464-015-4485-2

Cited by 121 publications

(78 citation statements)

References 11 publications

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“…In an analysis of 572,223 patients from the United Kingdom’s National Health Service database, the BDI rate was reported to be 0.09%. 6 In the US, Halbert and colleagues 11 analyzed 156,958 cholecystectomy patients from 2005 to 2010 from the New York State database and reported a BDI rate of 0.08%. The current analysis assessing 809,827 cholecystectomy patients from 2005 to 2014 in the state of California corroborates these findings, demonstrating a BDI rate of 0.22%.…”

Section: Discussionmentioning

confidence: 99%

“…Bile duct injury managed operatively was defined as patients undergoing choledochoenterostomy or suture of the common bile duct at the time of or after cholecystectomy, as well as patients undergoing a hepatectomy or liver transplantation after cholecystectomy, as defined previously in the literature. 9–11 Bile duct injury managed endoscopically was defined as patients undergoing more than 1 ERCP within a year after cholecystectomy. Bile duct injury managed percutaneously was defined as patients undergoing 1 or more percutaneous transhepatic cholangiography, more than 4 weeks but within 1 year after cholecystectomy.…”

Section: Methodsmentioning

confidence: 99%

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Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes

Fong

Pitt

Strasberg

et al. 2018

Journal of the American College of Surgeons

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BACKGROUND The increased incidence of bile duct injuries (BDIs) after the adoption of laparoscopic cholecystectomy has been well documented. However, the longitudinal impact of bile leaks and BDIs on survival and healthcare use have not been studied adequately. The aims of this analysis were to determine the incidence, long-term outcomes, and costs of bile leaks and ductal injuries in a large population. STUDY DESIGN The California Office of Statewide Health Planning and Development database was queried from 2005 to 2014. Bile leaks, BDIs, and their management strategy were defined. Survival was calculated by Kaplan-Meier failure estimates with multivariable regression and propensity analyses. Cost analyses used inflation adjustments and institution-specific cost-to-charge ratios. RESULTS Of 711,454 cholecystecomies, bile leaks occurred in 3,551 patients (0.50%) and were managed almost exclusively by endoscopists. Bile duct injuries occurred in 1,584 patients (0.22%) with 84% managed surgically. Patients with a bile leak were more likely to die at 1 year (2.4% vs 1.4%; odds ratio 1.85; p < 0.001). Similarly, BDI patients had an increased 1-year mortality (7.2% vs 1.3%; odds ratio 2.04; p < 0.0001). Survival of BDI patients was better with an operative approach (odds ratio 0.19; p < 0.001) when compared with endoscopic management. Operatively managed BDIs were also associated with fewer emergency department visits and readmissions, as well as lower cumulative costs at 1 year ($60,539 vs $118,245; p < 0.001). CONCLUSIONS The 0.22% incidence of BDIs observed in California is lower than reported in the first decade after the introduction of laparoscopic cholecystectomy. Bile leaks are 2.3 times more common than BDIs. Patients with a bile leak or BDI have diminished survival. Surgical repair of a BDI leads to enhanced survival and reduced cumulative cost compared with endoscopic management.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes

Fong

Pitt

Strasberg

et al. 2018

Journal of the American College of Surgeons

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“…Observation of every step in the procedure with application of standard measures is mandatory. Adequate skills and learning curve considerations should be undertaken to reduce the risk of complications [2]. Laparoscopy encourages more patients who are expecting cosmoses and early return to work to undergo surgery.…”

Section: Introductionmentioning

confidence: 99%

Subtotal laparoscopic cholecystectomy influences the rate of conversion in patients with difficult laparoscopic cholecystectomy: Case series

Abdelrahim

El-Siddig

Wahab

et al. 2017

Annals of Medicine &Amp; Surgery

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ObjectivesThis study aimed to show that subtotal laparoscopic cholecystectomy (SLC) is a safe procedure that reduces the rate of conversion in patients with difficult laporoscopic cholecystectomies in resource-meagre settings.Patients and methodsFollowing informed consent, patients with gallstones reporting to Atbara Medical Centre, Atbara, Northern Sudan from February 2012 to July 2013 were managed laparoscopically except those with choledocholithiasis. SLC was done for patients with difficult cholecystectomy and obscured Callot's triangle. Clinical presentation, duration of symptoms, ultrasound findings, frequency of conversion to open operation, frequency of difficult cholecystectomy, operation duration and numbers/types of complications were recorded. Statistical analysis was carried out using SPSS.ResultsOne hundred and nine patients with a median age of 48 years, F:M ratio of 9 and mean duration of symptoms of 14.8 ± 12.9 months were enrolled. A quarter (29/109, 26.6%) had acute choleycystitis, 13% had difficult laparoscopic cholecystectomy. SLC was done for 16.2%. Retained stones were statistically significant in patients who underwent subtotal laparoscopic cholecystectomy (p = 0.02) with a conversion rate of 5.5%.ConclusionSLC is feasible, safe and can reduce the rate of conversion for patients with difficult laporoscopic cholecystectomy. Sub-total laparoscopic cholecystectomy is not a substitute to conversion and in difficult conditions it is not a failure for the surgeon but a wisdom.

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“…1,2 Though a recent publication describes a decreasing rate of CBDI associated with laparoscopic cholecystectomy, 3 CBDI remains a serious concern for patients and surgeons. Despite studies identifying patient 1,4,5 and surgeon-related [5][6][7] factors associated with CBDI including inflammation and conversion to open cholecystectomy, approximately 30% of CBDI are not identified during the index operation 8 and may not be recognized until several days after the initial injury.…”

Section: Introductionmentioning

confidence: 99%

Comparing early and delayed repair of common bile duct injury to identify clinical drivers of outcome and morbidity

Kirks

Barnes

Lorimer

et al. 2016

HPB

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Beyond the learning curve: incidence of bile duct injuries following laparoscopic cholecystectomy normalize to open in the modern era

Abstract: In NYS, the rate of bile duct injury has now decreased to 0.08 % and mirrors the historical figures quoted for open cholecystectomy. This improvement likely reflects increased experience, improved instrumentation, and movement beyond the "learning curve."

Cited by 121 publications

References 11 publications

Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes

Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes

Subtotal laparoscopic cholecystectomy influences the rate of conversion in patients with difficult laparoscopic cholecystectomy: Case series

Comparing early and delayed repair of common bile duct injury to identify clinical drivers of outcome and morbidity

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