Critical view of safety faster and safer technique during laparoscopic cholecystectomy?

Mohammad Zarin,Muhammad Asim Khan,Maryam Alam Khan,Syed Asad Maroof Shah

doi:10.12669/pjms.343.14309

Abstract

Objective:Incidence of Bile Duct Injuries (BDI) during Laparoscopic Cholecystectomy (LC) is reported to be higher as compared to Open Cholecystectomy. Studies have shown varying degree of success in reducing BDI by using Critical View of Safety (CVS) technique before clipping and cutting any structure. In this study, we will see whether CVS technique is faster and safer compared to conventional infundibular technique.Methods:This comparative study was conducted on patients who presented to Surgical Out-Patient-Department (OPD) of Khyber Teaching Hospital from July 2015 to June 2016. Total of 438 patients were divided into two groups. Group-A in which LC was done using infundibular while in Group-B, CVS technique was utilized. Two groups were compared for operating time and BDI.Results:The operative time was significantly reduced for LC using CVS technique (50 mins vs. 73 mins). Minor leaks were comparable (0.5% vs. 0.9%) but there was a significant difference in major LEAKS between the two techniques (0.5% vs. 1.4%).Conclusion:Although the “critical view of safety” requires more dissection as compared to infundibular technique, but once learnt and mastered, it is faster and safer identification technique during laparoscopic cholecystectomy.

Highlights

Since its conception, Laparoscopic Cholecystectomy (LC) has gained worldwide popularity as the “Gold Standard” procedure for Cholecystectomy
Despite its rapid acceptance and international glory, a major drawback has been seen in the form of bile duct injuries (BDI)
In the initial days of LC, the rate of BDI was reported in the range of 0.5 to 2.7% as compared to Open Cholecystectomy 0.1-2.5%

Summary

INTRODUCTION

Laparoscopic Cholecystectomy (LC) has gained worldwide popularity as the “Gold Standard” procedure for Cholecystectomy. In the initial days of LC, the rate of BDI was reported in the range of 0.5 to 2.7% as compared to Open Cholecystectomy 0.1-2.5%.1-4. Strassberg[9] in early 1990s introduced Critical View of Safety (CVS) technique for identification and claimed that this identification technique will greatly reduce BDI rates. After its introduction, this CVS method was adopted by many surgeons. The objective of this study was to compare the traditional “Infundibular Technique” with the “Critical View of Safety” method for minimizing BDI’s in LC at a local level in terms of operative time and BDI

METHODS

DISCUSSION

CONCLUSION

REFRENCES