Avoidance of bile duct injury in laparoscopic cholecystectomy with feasible intraoperative resources: A cohort study

Ismaeil,Deari A.

doi:10.3892/br.2024.1798

Avoidance of bile duct injury in laparoscopic cholecystectomy with feasible intraoperative resources: A cohort study

Authors:
- Deari A. Ismaeil
View Affiliations

Affiliations: Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46001, Iraq
Published online on: June 5, 2024 https://doi.org/10.3892/br.2024.1798
Article Number: 110
Copyright : © Ismaeil . This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgeries and is considered the standard treatment for cholelithiasis. However, it is associated with a risk of bile duct or hepatic artery injuries. This study evaluated the safety of LCs and the conversion rate (CR) by achieving a critical view of safety (CVS) and identification of Rouviere's sulcus (RS). This was a single‑group cohort study that included consecutive patients undergoing LC at Smart Health Tower (Sulaimani, Iraq) from January 2021 to January 2023. The data were prospectively collected from patients' profiles or surgical notes within the hospital's database. A total of 419 patients underwent LC, of which females were the predominant gender (78.5%). The mean and median ages of the cases were 46.3±15.8 and 45 years, with a range of 2‑90 years, respectively. The most common indications for surgery were biliary colic (69.5%), followed by acute cholecystitis (23.9%). The duration of the operations was significantly shorter for cases in which the CVS (45.6±17.9 min) or identification of RS (45.6±18.6 min) was achieved compared to those where the CVS (63.7±27.7 min) or RS (50.7±21.7 min) was not observed. Surgeries for patients with both CVS achievement and RS identification were also significantly less time‑consuming (44.3±17.6) than counterparts (53.3±22.6). Among the cases without CVS achievement or RS identification (n=97, 23%), eight (8.2%) had adhesions, 12 (12.4%) had a distended gallbladder (GB) and 10 (10.3%) had thick GB walls. In addition, four (4.1%) experienced GB perforation, two (2.1%) had bleeding and one (1%) had stone spillage. There was no conversion. The achievement of CVS and identification of RS are practical landmarks in performing safe LC and decreasing the CR.

View Figures

View References

1	Hassler KR, Collins JT, Philip K and Jones MW: Laparoscopic cholecystectomy. In: StatPearls. StatPearls Publishing, Treasure Island, FL, 2022.
2	Lazarus L, Luckrajh JS, Kinoo SM and Singh B: Anatomical parameters of the rouviere's sulcus for laparoscopic cholecystectomy. Eur J Anat. 22:389–395. 2018.
3	Duca S, Bãlã O, Al-Hajjar N, Lancu C, Puia IC, Munteanu D and Graur F: Laparoscopic cholecystectomy: Incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB (Oxford). 5:152–158. 2003.PubMed/NCBI View Article : Google Scholar
4	Buddingh KT, Weersma RK, Savenije RA, van Dam GM and Nieuwenhuijs VB: Lower rate of major bile duct injury and increased intraoperative management of common bile duct stones after implementation of routine intraoperative cholangiography. J Am Coll Surg. 213:267–274. 2011.PubMed/NCBI View Article : Google Scholar
5	Elwan AM: Critical view of safety and Rouviere's sulcus: Extrahepatic biliary landmarks as a guide to safe laparoscopic cholecystectomy. Sci J Al-Azhar Med Faculty Girls. 3:297–301. 2019.
6	Cheruiyot I, Nyaanga F, Kipkorir V, Munguti J, Ndung'u B, Henry B, Cirocchi R and Tomaszewski K: The prevalence of the Rouviere's sulcus: A meta-analysis with implications for laparoscopic cholecystectomy. Clin Anat. 34:556–564. 2021.PubMed/NCBI View Article : Google Scholar
7	Pesce A, Palmucci S, La Greca G and Puleo S: Iatrogenic bile duct injury: Impact and management challenges. Clin Exp Gastroenterol. 12:121–128. 2019.PubMed/NCBI View Article : Google Scholar
8	Sgaramella LI, Gurrado A, Pasculli A, de Angelis N, Memeo R, Prete FP, Berti S, Ceccarelli G, Rigamonti M, Aldo Badessi FG, et al: The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study. Surg Endosc. 35:3698–3708. 2021.PubMed/NCBI View Article : Google Scholar
9	Jha AK, Dewan R and Bhaduria K: Importance of Rouviere's sulcus in laparoscopic cholecystectomy. Ann Afr Med. 19:274–277. 2020.PubMed/NCBI View Article : Google Scholar
10	Nickkholgh A, Soltaniyekta S and Kalbasi H: Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: A survey of 2,130 patients undergoing laparoscopic cholecystectomy. Surg Endosc. 20:868–874. 2006.PubMed/NCBI View Article : Google Scholar
11	Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C and Mathew G: STROCSS Group. STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery. Int J Surg. 72:156–1565. 2019.PubMed/NCBI View Article : Google Scholar
12	Muhialdeen AS, Ahmed JO, Baba HO, Abdullah IY, Hassan HA, Najar KA, Mikael TM, Mustafa MQ, Mohammed DA, Omer DA, et al: Kscien's List; A new strategy to discourage predatory journals and publishers. Barw Med J. 1:1–3. 2023.
13	Nip L, Tong KS and Borg CM: Three-port versus four-port technique for laparoscopic cholecystectomy: Systematic review and meta-analysis. BJS Open. 6(zrac013)2022.PubMed/NCBI View Article : Google Scholar
14	Mohammadi M, Shakiba B and Shirani M: Comparison of two methods of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed and complication in urologic surgery. Biomedicine (Taipei). 8(22)2018.PubMed/NCBI View Article : Google Scholar
15	Reinsoo A, Kirsimägi Ü, Kibuspuu L, Košeleva K, Lepner U and Talving P: Bile duct injuries during laparoscopic cholecystectomies: An 11-year population-based study. Eur J Trauma Emerg Surg. 49:2269–2276. 2023.PubMed/NCBI View Article : Google Scholar
16	Yang S, Hu S, Gu X and Zhang X: Analysis of risk factors for bile duct injury in laparoscopic cholecystectomy in China: A systematic review and meta-analysis. Medicine (Baltimore). 101(e30365)2022.PubMed/NCBI View Article : Google Scholar
17	Bansal VK, Asuri K, Jain M, Prakash O, Bhattacharjee HK, Isukapati S, Dey S, Baksi A, Khan WF, Subramaniam R, et al: Use of critical view of safety and proctored preceptorship in preventing bile duct injury during laparoscopic cholecystectomy-Experience of 3726 cases from a tertiary care teaching institute. Surg Laparosc Endosc Percutan Tech. 33:12–17. 2023.PubMed/NCBI View Article : Google Scholar
18	Ismaeil D, Salih B, Abdulla K, Ezzaddin S, Arif S and Saeed D: Comparison between critical view of safety and infundibular technique in laparoscopic cholecystectomy. J Sulaimani Med Coll. 9:421–425. 2019.
19	Griffiths EA, Hodson J, Vohra RS and Marriott P: CholeS Study Group. Katbeh T, Zino S and Nassar AHM: West Midlands Research Collaborative. Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surg Endosc. 33:110–121. 2019.PubMed/NCBI View Article : Google Scholar
20	Gupta N, Ranjan G, Arora MP, Goswami B, Chaudhary P, Kapur A, Kumar R and Chand T: Validation of a scoring system to predict difficult laparoscopic cholecystectomy. Int J Surg. 11:1002–1026. 2013.PubMed/NCBI View Article : Google Scholar
21	Nassar AH, Ashkar KA, Mohamed AY and Hafiz AA: Is laparoscopic cholecystectomy possible without video technology? Minimally Invasive Ther. 4:63–65. 1995.
22	Vivek MA, Augustine AJ and Rao R: A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy. J Minim Access Surg. 10:62–67. 2014.PubMed/NCBI View Article : Google Scholar
23	Sugrue M, Sahebally SM, Ansaloni L and Zielinski MD: Grading operative findings at laparoscopic cholecystectomy-a new scoring system. World J Emerg Surg. 10(14)2015.PubMed/NCBI View Article : Google Scholar
24	Strasberg SM: A three-step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy: An invited perspective review. J Hepatobiliary Pancreat Sci. 26:123–127. 2019.PubMed/NCBI View Article : Google Scholar
25	Van de Graaf FW, Zaïmi I, Stassen LP and Lange JF: Safe laparoscopic cholecystectomy: A systematic review of bile duct injury prevention. Int J Surg. 60:164–172. 2018.PubMed/NCBI View Article : Google Scholar
26	Stanisic V, Milicevic M, Kocev N and Stanisic B: A prospective cohort study for prediction of difficult laparoscopic cholecystectomy. Ann Med Surg (Lond). 60:728–733. 2020.PubMed/NCBI View Article : Google Scholar
27	Nassar AH, Zanati HE, Ng HJ, Khan KS and Wood C: Open conversion in laparoscopic cholecystectomy and bile duct exploration: Subspecialization safely reduces the conversion rates. Surg Endosc. 36:550–558. 2022.PubMed/NCBI View Article : Google Scholar
28	Kumar A, Shah R, Pandit N, Sah SP and Gupta RK: Anatomy of Rouviere's sulcus and its association with the complication of laparoscopic cholecystectomy. Minim Invasive Surg. 2020(3956070)2020.PubMed/NCBI View Article : Google Scholar
29	Goonawardena J, Gunnarsson R and De Costa A: Predicting conversion from laparoscopic to open cholecystectomy presented as a probability nomogram based on preoperative patient risk factors. Am J Surg. 210:492–500. 2015.PubMed/NCBI View Article : Google Scholar
30	Faraj FI, Da A, Hoaf F, Faruk HI, Deari A and Halkawt O: Laparoscopic cholecystectomy to open cholecystectomy in sulaymaniyah teaching hospital, incidence and risk factors assessment. Pak J Med Health Sci. 14:1244–1248. 2020.
31	Magnano San Lio R, Barchitta M, Maugeri A, Quartarone S, Basile G and Agodi A: Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: A systematic review and meta-analysis. Int J Environ Res Public Health. 20(408)2022.PubMed/NCBI View Article : Google Scholar
32	Hall C, Amatya S, Shanmugasundaram R, Lau NS, Beenen E and Gananadha S: Intraoperative cholangiography in laparoscopic cholecystectomy: A systematic review and meta-analysis. J Soc Laparoscopic Robotic Surg. 27(e2022)2023.PubMed/NCBI View Article : Google Scholar