Incidence, risk factors, and prevention of biliary tract injuries during laparoscopic cholecystectomy in Switzerland.

Details

Serval ID
serval:BIB_ABFE1A5D6CE8
Type
Article: article from journal or magazin.
Collection
Publications
Title
Incidence, risk factors, and prevention of biliary tract injuries during laparoscopic cholecystectomy in Switzerland.
Journal
World journal of surgery
Author(s)
Krähenbühl L., Sclabas G., Wente M.N., Schäfer M., Schlumpf R., Büchler M.W.
ISSN
0364-2313 (Print)
ISSN-L
0364-2313
Publication state
Published
Issued date
10/2001
Peer-reviewed
Oui
Volume
25
Number
10
Pages
1325-1330
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Bile duct injury (BDI) during laparoscopic cholecystectomy (LC) which may result in patient disability or death are reported to occur more frequently when compared to open surgery. The aim of this nationwide prospective study beyond the laparoscopic learning curve was to analyze the incidence, risk factors, and management of major BDI. During a 3-year period (1995-1997) 130 items of all LC data were collected on a central computer system from 84 surgical institutions in Switzerland by the Swiss Association of Laparoscopic and Thoracoscopic Surgery and evaluated for major BDIs. Simple biliary leakage was excluded from analysis. There were 12,111 patients with a mean age of 55 years (3-98 years) enrolled in the study. The overall BDI incidence was 0.3%, 0.18% for symptomatic gallstones, and 0.36% for acute cholecystitis. In cases of severe chronic cholecystitis with shrunken gallbladder, the incidence was as high as 3%. Morbidity and mortality rates were significantly increased in BDIs. BDI was recognized intraoperatively in 80.6%, in 64% of cases by help of intraoperative cholangiography. Immediate surgical repair was performed laparoscopically (suture or T-drainage) in 21%; in 79%, open repair (34% simple suture, 66% Roux-en-Y reconstruction) was needed. The BDI incidence did not decrease during the last 7 years. In 47%, BDIs were caused by experienced laparoscopic surgeons, perhaps because they tend to operate on more difficult patients. In conclusion, the incidence of major BDIs remains constant in Switzerland at a level of 0.3%, which is still higher when compared to open surgery. However, most cases are now detected intraoperatively and immediately repaired which ensures a good long-term outcome. For preventing such injuries, exact anatomical knowledge with its variants and a meticulous surgical dissecting technique especially in case of acute inflammation or shrunken gallbladder are mandatory.
Keywords
Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Bile Ducts/injuries, Child, Child, Preschool, Cholecystectomy, Laparoscopic/adverse effects, Cholecystitis/surgery, Cholelithiasis/surgery, Clinical Competence, Female, Humans, Incidence, Intraoperative Complications/epidemiology, Intraoperative Complications/prevention & control, Male, Middle Aged, Prospective Studies, Risk Factors, Switzerland/epidemiology
Pubmed
Web of science
Create date
11/12/2018 15:07
Last modification date
20/08/2019 16:15
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