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Open Access 01-07-2021 | Cholecystectomy

The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study

Authors: Lucia Ilaria Sgaramella, Angela Gurrado, Alessandro Pasculli, Nicola de Angelis, Riccardo Memeo, Francesco Paolo Prete, Stefano Berti, Graziano Ceccarelli, Marco Rigamonti, Francesco Giuseppe Aldo Badessi, Nicola Solari, Marco Milone, Fausto Catena, Stefano Scabini, Francesco Vittore, Gennaro Perrone, Carlo de Werra, Ferdinando Cafiero, Mario Testini, SYoN Italian Collaborative Group

Published in: Surgical Endoscopy | Issue 7/2021

Abstract

Background

Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3–0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial.

Methods

Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor.

Results

Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding.

The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding.

Conclusions

The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures.

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Title: The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study
Authors: Lucia Ilaria Sgaramella
Angela Gurrado
Alessandro Pasculli
Nicola de Angelis
Riccardo Memeo
Francesco Paolo Prete
Stefano Berti
Graziano Ceccarelli
Marco Rigamonti
Francesco Giuseppe Aldo Badessi
Nicola Solari
Marco Milone
Fausto Catena
Stefano Scabini
Francesco Vittore
Gennaro Perrone
Carlo de Werra
Ferdinando Cafiero
Mario Testini
SYoN Italian Collaborative Group
Publication date: 01-07-2021
Publisher: Springer US
Keyword: Cholecystectomy
Published in: Surgical Endoscopy / Issue 7/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07852-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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