RESUMO
BACKGROUND: Recent trials and metanalysis have demonstrated the favorable results of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) for the treatment of cholecysto-choledocholithiasis. The aim of this study was to evaluate the LC + LCBDE learning curve including transcystic and transductal approaches and its effect on the outcomes. METHODS: We identified all unselected patients who underwent LC + LCBDE by a single surgeon between May 2017 and July 2021. Pre-, intra-, and postoperative data were analyzed using the cumulative sum (CUSUM) analysis to evaluate the learning curve. RESULTS: A total of 110 patients were included. Total postoperative complications rate was 12.7%, including bile leakage in six (5.5%) patients. Mean length of hospital stay was 2.7 (1-14) days. No patient had conversion to open surgery. The CUSUM graph divided the learning curve into three distinct phases: (1) Learning (1-38), (2) Competence (39-61) and (3) Proficiency (62-110). There was a significant increase in the transcystic approach rate with each phase (44.7% vs 73.9% vs 98%; P < .001). A significant decrease in the operative time (150.9 vs 117.6 vs 99.9 min; P < .001) and complication rate (21.1% vs 21.7% vs 2%; P = .01) were observed across the three phases. CONCLUSION: Our data suggest that the learning curve for complete competence in LC + LCBDE is approximately 60 cases, provided that proper training is available. The initial learning phase can be carried out safely and efficiently with acceptable results.
Assuntos
Colecistectomia Laparoscópica , Coledocolitíase , Laparoscopia , Humanos , Curva de Aprendizado , Coledocolitíase/etiologia , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Complicações Pós-Operatórias/cirurgia , Ducto Colédoco/cirurgia , Estudos Retrospectivos , Tempo de InternaçãoRESUMO
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