A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases
Abstract Purpose Bile duct injury (BDI) is a catastrophic complication of cholecystectomy, and misidentification of the cystic anatomy is considered to be the main cause. Although several techniques have been developed to prevent BDI, such as the “critical view of safety”, the infundibular techniq...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
2020-07-01
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| Series: | Acta Cirúrgica Brasileira |
| Subjects: | |
| Online Access: | http://www.scielo.br/pdf/acb/v35n6/1678-2674-acb-35-6-e202000607.pdf |
| _version_ | 1818490613243314176 |
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| author | Peizhong Shang Bing Liu Xiaowu Li Jianjun Miao Ruichang Lv Weilin Guo |
| author_facet | Peizhong Shang Bing Liu Xiaowu Li Jianjun Miao Ruichang Lv Weilin Guo |
| author_sort | Peizhong Shang |
| collection | DOAJ |
| description | Abstract Purpose Bile duct injury (BDI) is a catastrophic complication of cholecystectomy, and misidentification of the cystic anatomy is considered to be the main cause. Although several techniques have been developed to prevent BDI, such as the “critical view of safety”, the infundibular technique, the rates remain higher during laparoscopic cholecystectomy (LC) than during open surgery. We, here, propose a practical new strategy for ductal identification, that can help to prevent laparoscopic bile duct injury. Methods A retrospective study of 5539 patients who underwent LC from March 2007 to February 2019 at a single institution was conducted. The gallbladder infundibulum was classified by its position located on an imaginary clock with the gallbladder neck as the center point of the dial, 3-o’clock position as cranial, 6-o’clock as dorsal, 9-o’clock as caudal, and 12-o’clock as ventral, as well as the axial position. Patient demographics, pathologic variables and infundibulum classification were evaluated. Detailed analysis of ductal identification based on gallbladder infundibulum position was performed in this study. All infundibulum positions were recorded by intraoperative laparoscopic video or photographic images. Results All the patients successfully underwent LC during the study period. No conversion or serious complications such as biliary injury occurred. Gallbladders with infundibulum of 3-o’clock position, 6-o’clock position, 9-o’clock position, 12-o’clock position, axial position were 12.3%, 23.4%, 28.0%, 4.2%, and 32.1%, respectively. The 3-o’clock and 12-o’clock position were pitfalls that might cause biliary injury. Conclusion The gallbladder infundibulum as a navigator is useful for ductal identification to reduce BDI and improve the safety of LC. |
| first_indexed | 2024-12-10T17:19:20Z |
| format | Article |
| id | doaj.art-3d2d9533cc1847979bee4ee341e58f40 |
| institution | Directory Open Access Journal |
| issn | 0102-8650 |
| language | English |
| last_indexed | 2024-12-10T17:19:20Z |
| publishDate | 2020-07-01 |
| publisher | Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia |
| record_format | Article |
| series | Acta Cirúrgica Brasileira |
| spelling | doaj.art-3d2d9533cc1847979bee4ee341e58f402022-12-22T01:40:02ZengSociedade Brasileira para o Desenvolvimento da Pesquisa em CirurgiaActa Cirúrgica Brasileira0102-86502020-07-0135610.1590/s0102-865020200060000007A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 casesPeizhong Shanghttps://orcid.org/0000-0002-5059-4156Bing Liuhttps://orcid.org/0000-0002-1865-5676Xiaowu Lihttps://orcid.org/0000-0002-0643-6038Jianjun Miaohttps://orcid.org/0000-0003-3898-9603Ruichang Lvhttps://orcid.org/0000-0003-0056-8969Weilin Guohttps://orcid.org/0000-0003-4855-5278Abstract Purpose Bile duct injury (BDI) is a catastrophic complication of cholecystectomy, and misidentification of the cystic anatomy is considered to be the main cause. Although several techniques have been developed to prevent BDI, such as the “critical view of safety”, the infundibular technique, the rates remain higher during laparoscopic cholecystectomy (LC) than during open surgery. We, here, propose a practical new strategy for ductal identification, that can help to prevent laparoscopic bile duct injury. Methods A retrospective study of 5539 patients who underwent LC from March 2007 to February 2019 at a single institution was conducted. The gallbladder infundibulum was classified by its position located on an imaginary clock with the gallbladder neck as the center point of the dial, 3-o’clock position as cranial, 6-o’clock as dorsal, 9-o’clock as caudal, and 12-o’clock as ventral, as well as the axial position. Patient demographics, pathologic variables and infundibulum classification were evaluated. Detailed analysis of ductal identification based on gallbladder infundibulum position was performed in this study. All infundibulum positions were recorded by intraoperative laparoscopic video or photographic images. Results All the patients successfully underwent LC during the study period. No conversion or serious complications such as biliary injury occurred. Gallbladders with infundibulum of 3-o’clock position, 6-o’clock position, 9-o’clock position, 12-o’clock position, axial position were 12.3%, 23.4%, 28.0%, 4.2%, and 32.1%, respectively. The 3-o’clock and 12-o’clock position were pitfalls that might cause biliary injury. Conclusion The gallbladder infundibulum as a navigator is useful for ductal identification to reduce BDI and improve the safety of LC.http://www.scielo.br/pdf/acb/v35n6/1678-2674-acb-35-6-e202000607.pdfCholecystectomy, LaparoscopicGallbladderCholecystitisBile DuctsAnatomy |
| spellingShingle | Peizhong Shang Bing Liu Xiaowu Li Jianjun Miao Ruichang Lv Weilin Guo A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases Acta Cirúrgica Brasileira Cholecystectomy, Laparoscopic Gallbladder Cholecystitis Bile Ducts Anatomy |
| title | A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases |
| title_full | A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases |
| title_fullStr | A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases |
| title_full_unstemmed | A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases |
| title_short | A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases |
| title_sort | practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy a single center experience with 5539 cases |
| topic | Cholecystectomy, Laparoscopic Gallbladder Cholecystitis Bile Ducts Anatomy |
| url | http://www.scielo.br/pdf/acb/v35n6/1678-2674-acb-35-6-e202000607.pdf |
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