Strategies to decrease bile duct injuries during laparoscopic cholecystectomy.
BACKGROUND
Laparoscopic cholecystectomy (LC) has been performed clinically for more than 20 years. However, the incidence of bile duct injury (BDI) remains high despite attempts to prevent and reduce it. The aim of this study was to use an intraoperative unfavorable factors ratings system to identify unfavorable intraoperative factors and evaluate the effectiveness of application of the system in reducing BDI during LC.


METHODS
Between January 2009 and December 2010, 780 patients who underwent LC were reviewed retrospectively, including 384 LC patients without graded treatment of intraoperative unfavorable factors (GTIUF) during 2009 and 396 LC patients with routine GTIUF during 2010.


RESULTS
BDI was decreased significantly after routine GTIUF (5 cases without GTIUF versus 0 cases with routine GTIUF; P=.029). There was no significant difference in postoperative morbidity and mortality between the two groups. The mean operation duration of the routine GTIUF group was prolonged significantly (P<.0001). Laparoscopic cholecystitis grading, GTIUF, and doctor's experience were important factors affecting the duration of operation (P<.0001, P<.0001, and P<.0001, respectively).


CONCLUSIONS
GTIUF is an effective method that emphasizes identification of the course of the extrahepatic bile duct and reduces the occurrence of BDI, especially for inexperienced operators.
1 Department of Pharmacy, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine , Shanghai, China .
Li-Xia
LX
Li
Kai Xin
KX
Ai
Yue Qin
YQ
Bai
Pin
P
Zhang
Xin-Yu
XY
Huang
Yong-Yang
YY
Li
D000328:Adult; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D001659:Biliary Tract / Q000000981:diagnostic imaging; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult