Abstract
Laparoscopic cholecystectomy has become the preferred choice of management for gallstone disease. In spite of various theories explored trying to assess different aspects of management and outcome to reach the acceptable safest technique in laparoscopic operation and to compare it with its counterpart. Many surgical methods were attempted to clarify their value in counteracting a serious complication of laparoscopic cholecystectomy, mainly is the bile duct injury. This study aimed to evaluate the significance of critical view of safety as a technique of laparoscopic cholecystectomy concerning the issue of preventing bile duct injury in regard to the infundibular technique of dissection. This is an observational study of two hundred fifty patients who were scheduled for laparoscopic cholecystectomy using critical view of safety technique compared with probably matched previously performed two hundred fifty of laparoscopic cholecystectomy using infundibular technique. The incidence of bile duct injury was analyzed in both groups. The results shows that age, sex, body mass index and gall bladder status were comparable in both groups. The Incidence of bile duct injury in infundibular technique was (1.6%), while in critical view of safety technique the incidence was 0% which is statistically significant (P
Highlights
In 1985, the first laparoscopic cholecystectomy (LC) was performed by Mühe of Böblingen, Germany, which adopted rapidly around the world and subsequently recognized as the "gold standard" for the treatment of gallstone disease[1,2].The introduction of LC was associated with a sharp rise in the incidence of bile duct injury (BDI)
Bile duct injury following LC is usually iatrogenic concerned with significant perioperative morbidity and mortality[7,8], The etiology of laparoscopic BDI is multifactorial and 70-80% of injury are due to anatomical misidentification of biliary system and its variations
We try to select a probably matched two hundred fifty patient to compare between the two technique(CVS and IT) and this clearly shown in table 1 that demonstrate the two groups were probably matched regarding the sex, age, body mass index (BMI) and GB status which shows no statistically significant difference (P value >0.05)
Summary
The introduction of LC was associated with a sharp rise in the incidence of bile duct injury (BDI). Despite the advancement of LC techniques, biliary injury continues to be an important problem[3], with an incidence range between 0.4-0.7%4-6. Bile duct injury following LC is usually iatrogenic concerned with significant perioperative morbidity and mortality[7,8], The etiology of laparoscopic BDI is multifactorial and 70-80% of injury are due to anatomical misidentification of biliary system and its variations. The other factor that affect BDI were gallbladder (GB) inflammation, obesity, excessive fat in dissection area, inadequate exposure, poor or excessive clip placement, injudicious use of electrocautery and bleeding in the operative field 9,10. The principal of infundibular technique(IT) was consist of clearance of Calot’s triangle from the fat and fibrous tissue and passing through a fatty free
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