Iatrogenic bile duct injuries.

BACKGROUND: The real incidence of bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is not known. METHODS: Using questionnaires, we analyzed 91,232 LC performed by 170 surgical units in Brazil between 1990 and 1997. RESULTS: A total of 167 BDI occurred (0.18%); the most frequent were Bismuth type 1 injuries (67.7%). Most injuries (56.8%) occurred at the hands of surgeons who had surpassed the learning curve (50 operations). However, the incidence dropped with increasing experience; it was 0.77% at surgical departments with <50 operations vs 0.16% at departments with >500 operations. The diagnosis was made intraoperatively in 67.7%, but it was based on intraoperative cholangiography in only 19.5%. The procedure was converted to open surgery in 85.8% when the diagnosis of injury occurred intraoperatively, and laparotomy was performed in 90.7% when the injury was diagnosed postoperatively. The mean hospitalization time was 7.6 +/- 5.9 days, the major complications were stenosis and fistulas, and the mortality rate was 4.2%. CONCLUSION: The incidence of BDI after LC is similar to that reported for the open procedure. BDI increases mortality and morbidity and prolongs hospitalization; therefore, all efforts should be made to reduce its incidence.

Laparoscopic cholecystectomy in Brazil: analysis of 33,563 cases.

The authors present the results obtained in 33,563 laparoscopic cholecystectomies performed in Brazil from 1990 to 1995. Data were obtained by mailing questionnaires to 220 Services, 118 of which responded. The features included the year when the service started its activities, patient distribution by sex and age, surgical indications, prophylaxis with antibiotics, use of nasogastric and vesical catheters, technique used to produce pneumoperitoneum, intraoperative cholangiography, management of choledocholithiasis, necessity and causes of conversion to open surgery, surgical time, intra and postoperative complications, time of hospitalization, mortality, patient return to normal activities, and laparoscopic cholecystectomy in pregnancy. Analysis of the results demonstrated that the data are equivalent to those obtained in leading world countries and at times even better in terms of lesion of the main bile duct, time of hospitalization, etc.

Evaluation of the routine use of the nasogastric tube in digestive operation by a prospective controlled study.

This prospective, randomized controlled trial was undertaken to evaluate the effect of tube decompression of the stomach after surgical procedure on the digestive tract. One hundred and nine patients were randomly allocated to postoperative treatment with (57 patients) or without (52 patients) nasogastric tubes. No significant differences were found between the two groups in the duration of hospitalization, time to begin peroral fluid intake, occurrence of hiccups, vomiting, nausea, parotiditis, nasal septum necrosis, anastomotic leak and wound dehiscence. Moreover, abdominal distension, pyrosis, otalgia, dysphagia, odynophagia and atelectasis occurred more often in intubated patients as shown by chi-square analysis of the data with Yates correction, with the level of significance at p = less than 0.05. Tube decompression of the stomach does not relieve intestinal paralysis after digestive operations. These data seem to indicate that the routine prophylactic use of a nasogastric tube is unnecessary in gastrointestinal operations.