Adopting “Culture of Safety for Laparoscopic Cholecystectomy” in a Rural Hospital: A Prospective Observational Study
Mohd Riyaz Lattoo, Prince Ajaz Ahmad, Sadaf Ali Bangri
Bile duct injury, Calot's triangle, Common bile duct, Cholangiography, Cholelithiasis, Laparoscopic cholecystectomy
Citation Information :
Lattoo MR, Ahmad PA, Bangri SA. Adopting “Culture of Safety for Laparoscopic Cholecystectomy” in a Rural Hospital: A Prospective Observational Study. World J Lap Surg 2021; 14 (3):191-194.
Background: The most feared complication of laparoscopic cholecystectomy is injury to bile duct. Different strategies have been proposed to avoid this serious complication. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) “Culture of Safe Cholecystectomy” is one such strategy.
Aim: This study was done to evaluate and validate SAGES “Culture of Safe Cholecystectomy” components modified and tailored to the setting of a rural hospital with emphasis on a bystander surgeon.
Materials and methods: This was a prospective study of 382 patients with gallstone disease who underwent surgery at District Hospital, Anantnag, a rural hospital from September 2016 to September 2018.
Results: Mean age of patients was 43 years. Two-hundred and ninety-eight (78%) patients were females, and 84 (22%) were male with male female ratio of 1:3.54. Most common indication was chronic cholecystitis in 213 patients (55.7%). Bystander surgeon was present in all cases. Critical view of safety (CVS) was achieved in 256 patients (67%). Rouviere's sulcus was present in 242 patients (63.3%). Bailout option was adopted in 19 patients (4.97%). Conversation to open cholecystectomy was done in 11 of the 382 patients (2.87%). Most common indication for conversion was inability to achieve CVS. Mean duration of surgery was 45 minutes. None of the patients in our study had bile duct injury.
Conclusion: SAGES culture of safe cholecystectomy can be modified to make it applicable to rural hospitals in developing countries where more reliance can be put on a detached bystander surgeon who is likely available in the vicinity.
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