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A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases
Shang, Peizhong; Liu, Bing; Li, Xiaowu; Miao, Jianjun; Lv, Ruichang; Guo, Weilin.
  • Shang, Peizhong; Department of General Surgery. Hospital of PLA 81st Group Army. Zhangjiakou. CN
  • Liu, Bing; Department of General Surgery. Hospital of PLA 81st Group Army. Zhangjiakou. CN
  • Li, Xiaowu; Department of General Surgery. Hospital of PLA 81st Group Army. Zhangjiakou. CN
  • Miao, Jianjun; Department of General Surgery. Hospital of PLA 81st Group Army. Zhangjiakou. CN
  • Lv, Ruichang; Department of General Surgery. Hospital of PLA 81st Group Army. Zhangjiakou. CN
  • Guo, Weilin; Department of General Surgery. Hospital of PLA 81st Group Army. Zhangjiakou. CN
Acta cir. bras ; 35(6): e202000607, 2020. tab, graf
Article in English | LILACS | ID: biblio-1130654
ABSTRACT
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.
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Full text: Available Index: LILACS (Americas) Main subject: Bile Duct Diseases / Cholecystectomy Type of study: Observational study / Prognostic study Limits: Adult / Aged / Aged80 / Female / Humans / Male Language: English Journal: Acta cir. bras Journal subject: General Surgery / Procedimentos Cir£rgicos Operat¢rios Year: 2020 Type: Article Affiliation country: China Institution/Affiliation country: Department of General Surgery/CN

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Full text: Available Index: LILACS (Americas) Main subject: Bile Duct Diseases / Cholecystectomy Type of study: Observational study / Prognostic study Limits: Adult / Aged / Aged80 / Female / Humans / Male Language: English Journal: Acta cir. bras Journal subject: General Surgery / Procedimentos Cir£rgicos Operat¢rios Year: 2020 Type: Article Affiliation country: China Institution/Affiliation country: Department of General Surgery/CN