Role of intraoperative cholangiography during endoscopic cholecystectomy.

Six hundred sixty-nine German hospitals participated in a survey on the use of intraoperative cholangiography (IOC) in its relationship to common bile duct injuries. Of these, 174 surgical departments are presently practicing IOC, 30 routinely. Only 16 injuries to the bile duct occurred in the 6,328 patients who underwent surgery in those 30 units. Approximately 80% of these injuries were discovered during surgery because of IOC and were treated immediately. A significant difference was found between these rates and those reported by units that performed IOC selectively. Only 58% of bile duct injuries were discovered at the time of surgery in units performing selective cholangiography. In addition, it appears that IOC helps to avoid bile duct injuries; the 30 units that performed routine IOC were defined as "learners," as they had performed fewer LCs, and yet they had a significant lower bile duct injury rate than "experienced" centers that did not perform IOC routinely.

[Quality of life--criterion in the treatment strategy of severely injured patients]. / Lebensqualität--Kriterium in der Behandlungsstrategie Schwerstverletzter.

A cohort study of 202 patients showed that all different aspects of quality of life--physical function, psychological function, social function and symptoms--were altered after multiple injury. Sixty-three percent of the patients rated their quality of life after trauma as average or bad. Since the quality of life is a relevant problem after trauma, it is necessary to use it as an important endpoint to judge results after multiple injury. Findings from such studies must be integrated into existing diagnostic and therapeutic concepts.