Is the Safe Cholecystectomy Technique Really Safe?

Sinan Soylu

doi:10.7197/cmj.1404025

EN TR

Is the Safe Cholecystectomy Technique Really Safe?

Abstract

Aim: This study aims to present the results of a single surgeon's experience to demonstrate the effectiveness of the 'Critical View of Safety' (CVS) technique in preventing bile duct injuries in clinical practice. Method: We retrospectively reviewed the records of 899 patients who underwent cholecystectomy using the CVS technique performed by a single surgeon at the Sivas Cumhuriyet University Hospital General Surgery Department between 2018 and 2023. Ethical approval for the study was obtained. Cholecystectomy cases were scanned retrospectively. The patients' age, gender, drain placement, surgery indications, and reason for switching to open cholecystectomy were recorded. Results: Among the 899 patients reviewed, 312 were male (34.70%), and 587 were female (65.30%). The average age was 55.10 for males and 51,65 for females. It was determined that 7(0.77%), cases converted to open cholecystectomy. The most common indication for cholecystectomy was elective gallbladder stone removal, accounting for 47.05% of cases. No major bile duct injuries were detected.. Conclusions: The safe cholecystectomy technique can be safely applied to avoid bile duct injuries in laparoscopic cholecystectomy.

Keywords

Güvenli Kolesistektomi Gerçekten Güvenli mi?

Öz

Amaç: Bu çalışma, klinik pratikte safra yolu yaralanmalarının önlenmesinde 'Eleştirel Güvenlik Görüşü' (CVS) tekniğinin etkinliğini göstermek için tek bir cerrahın deneyiminin sonuçlarını sunmayı amaçlamaktadır. Yöntem: 2018-2023 yılları arasında Sivas Cumhuriyet Üniversitesi Hastanesi Genel Cerrahi Anabilim Dalı'nda tek cerrah tarafından CVS tekniği kullanılarak kolesistektomi yapılan 899 hastanın kayıtları retrospektif olarak incelendi. Çalışma için etik onay alındı. Kolesistektomi olguları geriye dönük olarak tarandı. Hastaların yaşı, cinsiyeti, dren yerleşimi, ameliyat endikasyonları ve açık kolesistektomiye geçiş nedenleri kaydedildi. Bulgular: İncelenen 899 hastanın 312'si (%34,70) erkek, 587'si (%65,30) kadındı. Erkeklerde yaş ortalaması 55,10, kadınlarda ise 51,65’ idi. Olguların 7'sinin (%0,77) açık kolesistektomiye dönüştüğü belirlendi. Kolesistektominin en yaygın endikasyonu safra kesesi taşının elektif olarak çıkarılmasıydı ve vakaların %47,05'ini oluşturuyordu. Majör safra kanalı yaralanması tespit edilmedi. Sonuç: Laparoskopik kolesistektomide safra yolu yaralanmalarını önlemek için güvenli kolesistektomi tekniği güvenle uygulanabilir.

Anahtar Kelimeler

Kaynakça

1. Vollmer CM, Jr., Callery MP. (2007) Biliary injury following laparoscopic cholecystectomy: why still a problem? Gastroenterology 133: 1039–1041. https://doi.org/10.1053/j.gastro.2007.07.041, 2007/09/15
2. Way LW, Stewart L, Gantert W et al (2003) Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 237(4):460–469. https://doi.org/10.1097/01.SLA.0000060680. 92690.E9
3. The Southern Surgeons Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324(16):1073–1078. https://doi.org/10.1056/NEJM19910418324 1601 5.
4. Davidof AM, Pappas TN, Murray EA et al (1992) Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg 215(3):196–202 6.
5. Tornqvist B, Stromberg C, Persson G, Nilsson M (2012) Efect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ 345:e6457. https://doi.org/10.1136/bmj. e6457
6. Brittany Greene, Melanie Tsang, Shiva Jayaraman. The inferior boundary of dissection as a novel landmark for safe laparoscopic cholecystectomy. 2021; 23 (7):981-983. Doi:10.1016/j.hpb.2021.02.04.
7. Joshua Weis, Michael Brunt, Amin Madani, Dana Telem, Madhuri Nagaraj, Horacio Asbun,Briam R Davis, Sharmila Dissanaike,Michael B Ujiki,Carl J Wescott, Adnan Alseidi; SAGES Safe Chole Task Force. SAGES safe cholecystectomy modules improve practicing surgeons’judfment: results of a randomized,controlled trial. 2023; 37(2):862-870.
8. Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J. Am. Coll. Surg. 1995; 180: 101–25

9. Brunt LM, Deziel DJ, Telem DA et al. Safe cholecystectomy multisociety practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Ann. Surg. 2020; 272: 3–23.
10. Bansal VK, Misra M, Agarwal AK et al. SELSI consensus statement for safe cholecystectomy—prevention and management of bile duct injury—part B. Indian J. Surg. 2019; 83: 611–24. https://doi.org/10. 1007/s12262-019-01994-1
11. Moossa AR, Easter DW, Van Sonnenberg E, Casola G, D’Agostino H. Laparoscopic injuries to the bile duct. A cause for concern. Ann Surg 1992;215:203-8.
12. Khan MH, Howard TJ, Fogel EL, et al. Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center. Gastrointest Endosc 2007;65:247-52.
13. Wojcicki M, Patkowski W, Chmurowicz T, et al. Isolated right posterior bile duct injury following cholecystectomy: report of two cases. World J Gastroenterol 2013;19:6118-21.
14. Malik AM, Laghari AA, Talpur AH, Khan A. Iatrogenic biliary injuries during laparoscopic cholecystectomy. A continuing threat. Int J Surg 2008;6:392-5.
15. Avgerinos C, Kelgiorgi D, Touloumis Z, Baltatzi L, Dervenis C. One thousand laparoskopic Cholecystectomies in a single surgical unit using the ‘’Critical View of Safety’’ technique J Gastrointest Surg 2009; 13: 498-503.
16. Strasberg SM, Eagon CJ, Drebin JA. The «hidden cystic duct» syndrome and the infundibular technique of laparoscopic cholecystectomy—the danger of the false infundibulum. J Am Coll Surg 2000;191(3):661–667. doi:10.1016/S1072-7515(00) 00717-1. 14.
17. Strasberg SM. Biliary injury in laparoscopic surgery: Part 2. Changing the culture of cholecystectomy. J Am Coll Surg 2005;201(4):604–611. doi:10.1016/j.jamcollsurg.2005.04.032.
18. Fletcher DR, Hobbs MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ, Knuiman MW, Sheiner HJ, Edis A. Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population based study. Ann Surg 1999;229:449–457. doi:10.1097/00000658- 199904000-00001.
19. Flum DR, Koepsell T, Heagerty P, Sinanan M, Dellinger EP. Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error? Arch Surg 2001;136:1287–1292. doi:10.1001/ archsurg.136.11.1287.
20. Adams DB, Borowicz MR, Woolton FT III, Cunningham JT. Bile duct complications after laparoscopic cholecystectomy. Surg Endosc 1993;7:79–83. doi:10.1007/BF00704382.
21. Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG. Bile duct injury dyring laparoscopic cholecystectomy: results of a national survey. Am Surg 2001;234:549–559.

Ayrıntılar

Birincil Dil

İngilizce

Konular

Hasta Güvenliği

Bölüm

Araştırma Makalesi

Yazarlar

Sinan Soylu ^*
0000-0002-3911-3227
Türkiye

Yayımlanma Tarihi

31 Aralık 2023

Gönderilme Tarihi

12 Aralık 2023

Kabul Tarihi

27 Aralık 2023

Yayımlandığı Sayı

Yıl 2023 Cilt: 45 Sayı: 4

DOI

https://doi.org/10.7197/cmj.1404025

IZ

https://izlik.org/JA27ZH69BY

Kaynak Göster

RIS / Bibtex

AMA

1.Soylu S. Is the Safe Cholecystectomy Technique Really Safe? CMJ. 2023;45(4):73-77. doi:10.7197/cmj.1404025