Critical View of Safety on Bile Duct Injuries During Laparoscopic Cholecystectomy: A Retrospective Study
DOI:
https://doi.org/10.54361/LJMR.20.1.18Keywords:
Bile Duct Injuries, Critical View Of Safety, Laparoscopic Cholecystectomy, Open Surgery, Nassar GradingAbstract
Background: Laparoscopic cholecystectomy helps treat gallbladder stones with injuries in the bile duct (BDI). A critical view of safety (CVS) is introduced to reduce the risk of misidentification of BDI. Thus, this study aims to evaluate the routine use of CVS on bile duct injuries during laparoscopic surgery in the surgical unit of Almgreaf Ajdabiya Teaching Central Hospital in Libya. Method: The study included 138 randomly selected patients aged 70-79 years, diagnosed with gallbladder stones and admitted to one surgical unit. These patients underwent laparoscopic cholecystectomy from January 2018 to December 2018. Result: The findings revealed that a critical view of Safety (CVS) was achieved in 135 cases, while no injuries in the bile duct were reported within the cases. The majority of patients were aged 30–39 years (n = 48, 34.8%), and most of them were female (45/48). The lowest frequency was observed in the 70–79-year age group (n = 3, 2.2%). Overall, females constituted 120 cases (87.0%), while males accounted for 18 cases (13.0%). Compared to males, females had a higher incidence of biliary colic, chronic calculus cholecystitis, empyema of the gallbladder, and gallbladder polyps. Furthermore, females presented with a greater number of preoperative diagnoses than male patients. Conclusion: The study concluded that routine use of a critical view of safety during laparoscopic cholecystectomy is a safer and reproducible technique for identifying the biliary anatomy and its association with minor bile duct injuries.
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1. Hassler KR, Collins JT, Philip K, Jones MW. Laparoscopic cholecystectomy [Internet]. StatPearls - NCBI Bookshelf. 2023.
2. Patil M, Gharde P, Reddy K, Nayak K. Comparative analysis of laparoscopic versus open procedures in specific general surgical interventions. Cureus. 2024 Feb 19; https://doi.org/10.7759/cureus.54433
3. Majumder A, Altieri MS, Brunt LM. How do I do it: laparoscopic cholecystectomy. Annals of Laparoscopic and Endoscopic Surgery. 2020 Apr 1;5:15. https://doi.org/10.21037/ales.2020.02.06
4. Calland JF, Tanaka K, Foley E, Bovbjerg VE, Markey DW, Blome S, et al. Outpatient laparoscopic cholecystectomy: patient outcomes after implementation of a clinical pathway. Annals of Surgery. 2001 May 1;233(5):704–15. https://doi.org/10.1097/00000658-200105000-00015
5. Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG. Bile duct injury during laparoscopic cholecystectomy. Annals of Surgery. 2001 Oct 1;234(4):549–59. https://doi.org/10.1097/00000658-200110000-00014
6. Voruganti MR, Mohammed N, Sangani VA, Kumar BA. Evaluation of critical view of safety in laparoscopic cholecystectomy. International Journal of Surgery Science [Internet]. 2022 Jan 1;6(1):01–5. https://doi.org/10.33545/surgery.2022.v6.i1a.805
7. Strasberg SM, Eagon CJ, Drebin JA. The “Hidden Cystic Duct” Syndrome and The Infundibular Technique of Laparoscopic Cholecystectomy—The Danger of The False Infundibulum. Journal of the American College of Surgeons [Internet]. 2000 Dec 1;191(6):661–7. https://doi.org/10.1016/s1072-7515(00)00717-1
8. Sgaramella LI, Gurrado A, Pasculli A, De Angelis N, Memeo R, Prete FP, et al. The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study. Surgical Endoscopy [Internet]. 2020 Aug 11;35(7):3698–708. https://doi.org/10.1007/s00464-020-07852-6
9. Strasberg SM. A three‐step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy: an invited perspective review. Journal of Hepato-Biliary-Pancreatic Sciences [Internet]. 2019 Mar 4;26(4):123–7. https://doi.org/10.1002/jhbp.616
10. Strasberg SM, Brunt ML. Rationale and use of the Critical View of Safety in Laparoscopic cholecystectomy. Journal of the American College of Surgeons [Internet]. 2010 May 27;211(1):132–8. Available from: https://doi.org/10.1016/j.jamcollsurg.2010.02.053
11. Strasberg SM, Brunt LM. The critical view of safety. Annals of Surgery [Internet]. 2016 Oct 20;265(3):464–5. Available from: https://doi.org/10.1097/sla.0000000000002054
12. Yegiyants S, Collins JC. Operative strategy can reduce the incidence of major bile duct injury in laparoscopic cholecystectomy. The American Surgeon [Internet]. 2008 Oct 1;74(10):985–7. Available from: https://doi.org/10.1177/000313480807401022
13. Duepree HJ, Senagore AJ, Delaney CP, Brady KM, Fazio VW. Advantages of laparoscopic resection for ileocecal Crohn’s Disease. Diseases of the Colon & Rectum [Internet]. 2002 May 1;45(5):605–10. Available from: https://doi.org/10.1007/s10350-004-6253-6
14. Gabash KM, Muzhir HK. The commonest clinical presentation of gallstone disease in laparoscopically cholecystectomized patients. Indian Journal of Forensic Medicine & Toxicology [Internet]. 2021 May 12; Available from: https://doi.org/10.37506/ijfmt.v15i3.15815
15. The result of the Critical View of Safety timeout Technique in Prevention of bile duct injury in laparoscopic cholecystectomy: a retrospective study at a large community teaching hospital. Journal of the Medical Association of Thailand [Internet]. 2022 Mar 15;105(3):200–7. Available from: https://doi.org/10.35755/jmedassocthai.2022.03.13277
16. Vettoretto N, Saronni C, Harbi A, Balestra L, Taglietti L, Giovanetti M. Critical view of safety during laparoscopic cholecystectomy. JSLS Journal of the Society of Laparoscopic & Robotic Surgeons [Internet]. 2011 Jan 1;15(3):322–5. https://doi.org/10.4293/108680811x13071180407474
17. Avgerinos C, Kelgiorgi D, Touloumis Z, Baltatzi L, Dervenis C. One thousand laparoscopic cholecystectomies in a single surgical unit using the “Critical View of Safety” technique. Journal of Gastrointestinal Surgery [Internet]. 2008 Nov 13;13(3):498–503. https://doi.org/10.1007/s11605-008-0748-8
18. Duca S, Bãlã O, Al‐Hajjar N, Iancu C, Puia IC, Munteanu D, et al. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB [Internet]. 2003 Aug 1;5(3):152–8. https://doi.org/10.1080/13651820310015293
19. Melly C, McGeehan G, O’Connor N, Johnston A, Bass G, Mohseni S, et al. Patient-reported outcome measures (PROMs) after laparoscopic cholecystectomy: systematic review. BJS Open [Internet]. 2022 Apr 14;6(3). Available from: https://doi.org/10.1093/bjsopen/zrac062
20. Chattopadhyay K, Das R. Laparoscopic and open cholecystectomy: A comparative study. International Journal of Surgery Science [Internet]. 2020 Jan 1;4(1):427–30. https://doi.org/10.33545/surgery.2020.v4.i1h.375
21. Warchałowski Ł, Łuszczki E, Bartosiewicz A, Dereń K, Warchałowska M, Oleksy Ł, et al. The Analysis of Risk Factors in the Conversion from Laparoscopic to Open Cholecystectomy. International Journal of Environmental Research and Public Health [Internet]. 2020 Oct 18;17(20):7571. https://doi.org/10.3390/ijerph17207571
22. Toskovic B, Bilanovic D, Resanovic A, Todorovic S, Mrda D, Crnokrak B, et al. Management of major bile duct injuries following laparoscopic and open cholecystectomy - single centre experience. Srpski Arhiv Za Celokupno Lekarstvo [Internet]. 2019 Jan 1;147(7–8):422–6. Available from: https://doi.org/10.2298/sarh190206030t
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