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World Journal of Surgery

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01-07-2015 | Original Scientific Report

Complications After Laparoscopic Cholecystectomy: A Video Evaluation Study of Whether the Critical View of Safety was Reached

Authors: M. A. J. Nijssen, J. M. J. Schreinemakers, Z. Meyer, G. P. van der Schelling, R. M. P. H. Crolla, A. M. Rijken

Published in: World Journal of Surgery | Issue 7/2015

Abstract

Background

Achieving the critical view of safety (CVS) before transection of the cystic artery and duct is important to reduce biliary duct injury in laparoscopic cholecystectomy. To gain more insight into complications after laparoscopic cholecystectomy, we investigated whether the criteria for CVS were met during surgery by analyzing videos of operations performed at our institution.

Methods

All consecutive patients who underwent a completed laparoscopic cholecystectomy between 2009 and 2011 were included. The videos of the operations of patients with complications were independently reviewed and rated by two investigators with a third consulted in the event of a disagreement. The reviewers answered consecutive questions about whether the CVS criteria were met. Patients who underwent an elective laparoscopic cholecystectomy and had no complications were used as a control group for comparison.

Results

Of the 1108 consecutive patients who had undergone a laparoscopic cholecystectomy during the study period, 8.8 % developed complications (average age 51 years) and 1.7 % had bile duct injuries [six patients (0.6 %) had a major bile duct injury, type B, D, or E injury]. In the 65 surgical videos available for analysis, CVS was reached in 80 % of cases according to the operative notes. However, the reviewers found that CVS was reached in only 10.8 % of the cases. Only in 18.7 % of the cases the operative notes and video agreed about CVS being reached. CVS was not reached in any of the patients who had biliary injuries. In the control group, CVS was reached significantly more often in 72 %.

Conclusions

In our institutional series of laparoscopic cholecystectomies with postoperative complications, CVS was reached in only a few cases. Evaluating surgical videos of laparoscopic cholecystectomy cases are important and we recommend its use to improve surgical technique and decrease the number of biliary injuries.

Keus F, de Jong JA, Gooszen HG et al (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev (4):CD006231. doi:10.1002/14651858.CD006231

A prospective analysis of 1518 laparoscopic cholecystectomies (1991) The Southern Surgeons Club. N Engl J Med 324(16):1073–1078

Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180(1):101–125PubMed

J.F. Lange LPSS (2006). Best practice: De techniek van de laparoscopische cholecystectomie (Critical View of Safety [CVS]; Werkgroep Endoscopische Chirurgie van de Nederlandse Vereniging voor Heelkunde)

Jorgensen T, Teglbjerg JS, Wille-Jorgensen P et al (1991) Persisting pain after cholecystectomy. A prospective investigation. Scand J Gastroenterol 26(1):124–128PubMedCrossRef

Nuzzo G, Giuliante F, Giovannini I et al (2005) Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. Arch Surg 140(10):986–992PubMedCrossRef

Vollmer CM Jr, Callery MP (2007) Biliary injury following laparoscopic cholecystectomy: why still a problem? Gastroenterology 133(3):1039–1041PubMedCrossRef

Buddingh KT, Nieuwenhuijs VB, van Buuren L, Hulscher JB, de Jong JS, van Dam GM (2011) Intraoperative assessment of biliary anatomy for prevention of bile duct injury: a review of current and future patient safety interventions. Surg Endosc 25(8):2449–2461PubMedCentralPubMedCrossRef

Schols RM, Bouvy ND, van Dam RM, Masclee AA, Dejong CH, Stassen LP (2013) Combined vascular and biliary fluorescence imaging in laparoscopic cholecystectomy. Surg Endosc 27(12):4511–4517PubMedCrossRef

10.

Tornqvist B, Stromberg C, Persson G, Nilsson M (2012) Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ 345:e6457PubMedCentralPubMedCrossRef

11.

Hunter JG (1991) Avoidance of bile duct injury during laparoscopic cholecystectomy. Am J Surg 162(1):71–76PubMedCrossRef

12.

Hugh TB, Kelly MD, Mekisic A (1997) Rouviere’s sulcus: a useful landmark in laparoscopic cholecystectomy. Br J Surg 84(9):1253–1254PubMedCrossRef

13.

Hugh TB (2002) New strategies to prevent laparoscopic bile duct injury–surgeons can learn from pilots. Surgery 132(5):826–835PubMedCrossRef

14.

Wauben LS, Goossens RH, van Eijk DJ et al (2008) Evaluation of protocol uniformity concerning laparoscopic cholecystectomy in the Netherlands. World J Surg 32(4):613–620. doi:10.1007/s00268-007-9323-9 PubMedCentralPubMedCrossRef

15.

Emous M, Westerterp M, Wind J et al (2010) Registering the critical view of safety: photo or video? Surg Endosc 24(10):2527–2530PubMedCrossRef

16.

Kennedy TM, Jones RH (2000) Epidemiology of cholecystectomy and irritable bowel syndrome in a UK population. Br J Surg 87(12):1658–1663PubMedCrossRef

17.

Thurley PD, Dhingsa R (2008) Laparoscopic cholecystectomy: postoperative imaging. AJR Am J Roentgenol 191(3):794–801PubMedCrossRef

18.

Khan MH, Howard TJ, Fogel EL et al (2007) Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center. Gastrointest Endosc 65(2):247–252PubMedCrossRef

19.

Wauben LS, van Grevenstein WM, Goossens RH et al (2011) Operative notes do not reflect reality in laparoscopic cholecystectomy. Br J Surg 98(10):1431–1436PubMedCrossRef

Title: Complications After Laparoscopic Cholecystectomy: A Video Evaluation Study of Whether the Critical View of Safety was Reached
Authors: M. A. J. Nijssen
J. M. J. Schreinemakers
Z. Meyer
G. P. van der Schelling
R. M. P. H. Crolla
A. M. Rijken
Publication date: 01-07-2015
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-2993-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Complications After Laparoscopic Cholecystectomy: A Video Evaluation Study of Whether the Critical View of Safety was Reached

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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