Retroinfundibular laparoscopic cholecystectomy versus standard laparoscopic cholecystectomy in difficult cases

Sewefy, Alaa M.; Hassanen, Aymen M.; Atyia, Ahmed M.; Gaafar, Amr M.

doi:10.1016/j.ijsu.2017.05.044

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…Several studies have shown how the "fundus-first" technique is associated with reduced rates conversion rate and iatrogenic complications (including BDIs) during difficult operations, such as in cases of severe AC [49][50][51][52], although the risk of vascular and biliary injuries cannot be completely eliminated [10,53]. It is essential to recognize approaching areas of danger during LC and, in response, stop dissection and change to a bailout procedure (STC or cholecystostomy) to minimize the need for conversion and to reduce the risk of BDI [48,[54][55][56]. However, STC is associated with significantly more surgical site infections, a need for re-interventions, and a longer hospital stay than total cholecystectomy [57].…”

Section: Bailout Proceduresmentioning

confidence: 99%

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2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

et al. 2021

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Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4–1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.

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Section: Bailout Proceduresmentioning

confidence: 99%

“…55 Unit of Gastroenterology and Endoscopy, Maggiore Hospital, Bologna, Italy. 56 Department of Surgery, UPMC, University of Pittsburg, School of Medicine, Pittsburg, USA. 57 General Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.…”

Section: Acknowledgementsmentioning

confidence: 99%

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

et al. 2021

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“…BDI was not specified. A prospective, non-randomized trial compared results between patients with preoperative predictors for difficult cholecystectomy based on an objective scoring system [87]. Sixty-five patients who underwent a version of subtotal laparoscopic cholecystectomy had no BDI and one conversion.…”

Section: Laparoscopic Subtotal Cholecystectomymentioning

confidence: 99%

Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy

et al. 2020

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Background Bile duct injury (BDI) is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI. Methods Literature reviews were conducted for 18 key questions across six broad topics around cholecystectomy directed by a steering group and subject experts from five surgical societies (SAGES, AHPBA IHPBA, SSAT, and EAES). Evidencebased recommendations were formulated using the GRADE methodology. When evidence-based recommendations could not be made, expert opinion was documented. A number of recommendations for future research were also documented. Recommendations were presented at a consensus meeting in October 2018 and were voted on by an international panel of 25 experts with greater than 80% agreement considered consensus. Results Consensus was reached on 17 of 18 questions by the Guideline Development Group (GDG) and expert panel with high concordance from audience participation. Most recommendations were conditional due to low certainty of evidence. Strong recommendations were made for (1) use of intraoperative biliary imaging for uncertainty of anatomy or suspicion of biliary injury; and (2) referral of patients with confirmed or suspected BDI to an experienced surgeon/multispecialty hepatobiliary team. Conclusion These consensus recommendations should provide guidance to surgeons, training programs, hospitals, and professional societies for strategies that have the potential to reduce BDIs and positively impact patient outcomes. Development of clinical and educational research initiatives based on these recommendations may drive further improvement in the quality of surgical care for patients undergoing cholecystectomy.

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“…In literature, Sewefy et al mentions operative time to be (114±10 minute), which was comparable with our study. 4 In a study by Atta the operative time taken by experienced surgeon for laparoscopic cholecystectomy is 30-70 minutes. The gall bladder wall thickness of≥4mm was taken as difficult operation.…”

Section: Calculous Cholecystitismentioning

confidence: 99%

“…It is because of subjectivity. Studies have used preoperative scoring parameters to define a difficult operation [4][5][6]. However, we have not used them in our study.…”

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confidence: 99%

Intraoperative strategies to overcome difficulties in laparoscopic cholecystectomy for chronic calculous cholecystitis

Singh

Goel

2021

Int Surg J

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Background: Surgery in chronic cholecystitis is very challenging because of inability to hold the gall bladder, dense adhesions, frozen Calot’s triangle and difficulty in applying clips. Precise and meticulous dissection is required to establish critical view of safety. There is no consensus among surgeons about appropriate intraoperative steps in difficult gall bladder (GB) surgery. The authors aim to present various intraoperative difficulties and strategies to overcome them. Methods: A prospective study of 81 patients of chronic cholecystitis was done in our institution. They were divided in two groups. Group A in which surgery could be done easily. Group B in which surgery was difficult and different intraoperative strategies were applied to overcome them. Results: Total 42 patients were included in group A and 39 patients in group B. Various difficulties encountered while performing laparoscopic cholecystectomy in group B were adhesions (53.8 %), inability to grasp the fundus of GB (15.3%), frozen Calot’s triangle (15.3%), inability to grasp the Hartmann’s pouch (12.8%) and cystic duct edema (2.5%). Conclusions: Intraoperative technique of identification of Rouviere′s sulcus first, followed by high peritoneal incision on the GB body. Subsequently blunt dissection of Calot’s triangle using gauze piece and hydro dissection by suction irrigation canula ventral to the sulcus. It created a retro gall bladder tunnel safely. It established the critical view of safety in all our cases.

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Retroinfundibular laparoscopic cholecystectomy versus standard laparoscopic cholecystectomy in difficult cases

Abstract: In difficult cholecystectomy, RI approach is feasible and safe alternative to SLC.

Cited by 11 publications

References 19 publications

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy

Intraoperative strategies to overcome difficulties in laparoscopic cholecystectomy for chronic calculous cholecystitis

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