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VOLUME 14 , ISSUE 3 ( September-December, 2021 ) > List of Articles

RESEARCH ARTICLE

Adopting “Culture of Safety for Laparoscopic Cholecystectomy” in a Rural Hospital: A Prospective Observational Study

Mohd Riyaz Lattoo, Prince Ajaz Ahmad, Sadaf Ali Bangri

Keywords : 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.

DOI: 10.5005/jp-journals-10033-1470

License: CC BY-NC 4.0

Published Online: 05-03-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

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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  1. Truven health analytics (Thomson/Solucient). USA Procedure Volumes; 2014.
  2. National Institutes of Health. National Institute of Health consensus development conference statement on gallstones and laparoscopic cholecystectomy. Am J Surg 1993;165(4):390–398. DOI: 10.1016/s0002-9610(05)80929-8.
  3. Connar S and Garden OJ. Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 2006;93(2):158–168. DOI: 10.1002/bjs.5266.
  4. MacFadyen BV Jr, Vecchio R, Ricardo AE, et al. Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc 1988;12(4):315–321. DOI: 10.1007/s004649900661.
  5. Slater K, Strong RW, Wall DR, et al. Iatrogenic bile duct injury: the scourge of laparoscopic cholecystectomy. ANZ J Surg 2002;72(2): 83–88. DOI: 10.1046/j.1445-2197.2002.02315.x.
  6. Way LW, Stewart L, Ganter W, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 2003;237(4): 460–469. DOI: 10.1097/01.SLA.0000060680.92690.E9.
  7. Pucher PH, Brunt LM, Fanelli RD, et al. SAGES expert Delphi consensus: critical factors for safe surgical practice in laparoscopic cholecystectomy. Surg Endosc 2015;29(11):3074–3085. DOI: 10.1007/s00464-015-4079-z.
  8. Teilum D. The prevalence of gallstones in autopsies from a Danish urban area. Frederiksberg 1914-1955. Acta Chir Scand 1989;155(2): 103–106. PMID: 2787087.
  9. Schirmer BD, Winters KL, Edlich RF. Cholelithiasis and cholecystitis. J Long Term Eff Med Implants 2005;15(3):329–338. DOI: 10.1615/jlongtermeffmedimplants.v15.i3.90.
  10. Calland JF, Tanaka K, Foley E, et al. Outpatient laparoscopic cholecystectomy: patient out-comes after implementation of a clinical pathway. Ann Surg 1998;227(3):343–350. PMID: 11323509.
  11. Shea JA, Berlin JA, Bachwich DR, et al. Indication for and outcomes of cholecystectomy: a comparison of the pre and postlaparoscopic eras. Ann Surg 1998;227(3):343–350. DOI: 10.1097/00000658-199803000-00005.
  12. Lillemoe KD, Lin JW, Talamini MA, et al. Laparoscopic cholecystectomy as a “true” outpatient procedure: initial experience in 130 consecutive patients. J Gastrointest Surg 1999;3(1):44–49. PMID 10457323.
  13. Giger UF, Michel JM, Opitz, et al. Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: analysis of 22,953 consecutive cases from the Swiss Association of Laparoscopic and Thoracoscopic Surgery database. J Am Coll Surg 2006;203(5):723–728. DOI: 10.1016/j.jamcollsurg.2006.07.018.
  14. Altieri MS, Brunt LM. Elimination of bile duct injury in cholecystectomy. In: Cameron JL, editor. Advances in surgery. p. 145–160.
  15. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg 2010;211(1): 132–138. DOI: 10.1016/j.jamcollsurg.2010.02.053.
  16. Yegiyants S, Collins JC. Operative strategy can reduce the incidence of major bile duct injury in laparoscopic cholecystectomy. Am Surg 2008;74(10):985–987. PMID: 18942628.
  17. Auyang ED, Hungness ES, Vazir K, et al. Natural orifice transluminal endoscopic surgery (NOTES): dissection for the critical view of safety during transcolonic cholecystectomy. Surg Endosc 2009;23(5): 117–118. DOI: 10.1007/s00464-009-0407-5.
  18. Avgerinas C, Kelgiorgi D, Touloumis Z, et al. One thousand laparoscopic cholecystectomies in a single surgical unit using the “critical view of safety” technique. J Gastrointest Surg 2009;13(3): 498–503. DOI: 10.1007/s11605-008-0748-8.
  19. Heistermann HP, Tobusch A, Palmes D. Prevention of bile duct injuries after laparoscopic cholecystectomy. “The critical view of safety.” Zentralbl Chir 2006;131(6):460–465. DOI: 10.1055/s-2006-957031.
  20. Huge TB. New Strategies to prevent laparoscopic bile duct injury. Surgeons can learn from pilots. Surgery 2002;132(5):826–835. DOI: 10.1067/msy.2002.127681.
  21. Huge TB, Kelly MD, Mekisic A. Rouviere's sulcus: a useful landmark in laparoscopic cholecystectomy. Br J Surg 1997;84(9):1253–1235. DOI: 10.1046/j.1365-2168.1997.02769.x.
  22. Singh K, Ohri A. Anatomic landmarks: their usefulness in safe laparoscopic cholecystectomy. Surg Endosc 2006;20(11):1754–1758. DOI: 10.1007/s00464-005-0528-4.
  23. Ladocsi LT, Benitez LD, Filippone DR, et al. Intraoperative cholangiography in laparoscopic cholecystectomy: a review of 734 consecutive cases. Am Surg 1997;63(2):150–156. PMID: 9012429.
  24. Sheffield KM, Riall TS, Han Y, et al. Association between cholecystectomy with vs without intraoperative cholangiography and risk of common duct injury. JAMA 2013;310(8):812–820. DOI: 10.1001/jama.2013.276205.
  25. Hope WW Fanelli R, Walsh DS, et al. SAGES clinical spotlight review: intraoperative cholangiography. Surg Endosc 2017;31(5):2007–2016. DOI: 10.1007/s00464-016-5320-0.
  26. Ford JA, Soop M, Du J, et al. Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg 2012;99(2):160–167. DOI: 10.1002/bjs.7809.
  27. Biffl WL, Moore EE, Offner PJ, et al. Routine intraoperative laparoscopic ultrasonography with selective cholangiography reduces bile duct complication during laparoscopic cholecystectomy. J Am Coll Surg 2001;193(3):272–280. DOI: 10.1016/s1072-7515(01)00991-7.
  28. Machi J, Johnson JO, Deziel DJ, et al. The routine use of laparoscopic ultrasound decreases bile duct injury: a multicenter study. Surg Endosc 2009;23(2):384–388. DOI: 10.1007/s00464-008-9985-x.
  29. Kapoor VK. ‘Calleaguography’ in place of cholangiography, to prevent bile duct injury during laparoscopic cholecystectomy. J Minim Access Surg 2019;15(3):273–274. DOI: 10.4103/jmas.JMAS_165_18.
  30. Sutherland F, Dixion E. The importance of cognitive map placement in bile duct injuries. Can J Surg 2017;60(6):424–425. DOI: 10.1503/cjs.008816.
  31. Lattoo MR, Mirab M, Khaki MS, et al. Relevance of a detached observer in laparoscopic cholecystectomy: an observation study. World J Pharm Res 2019;8(4):785–788. DOI: 10.20959/wjpr20194-14518.
  32. Hori T, Oike F, Furuyama H, et al. Protocol for laparoscopic cholecystectomy: is it rocked science. World J Gastroenterol 2016;22(47): 10287–10303. DOI: 10.3748/wjg.v22.i47.10287.
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