Prevention Of Bile Duct Injury Research Articles

Near-infrared cholangiography with intragallbladder indocyanine green injection in minimally invasive cholecystectomy.

Laparoscopic cholecystectomy (LC) remains one of the most commonly performed procedures in adult and paediatric populations. Despite the advances made in intraoperative biliary anatomy recognition, iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems. A series of methods have been proposed to prevent bile duct injury, among them the use of indocyanine green (ICG) fluorescence. The most commonly reported method of ICG injection is the intravenous administration, while literature is lacking studies investigating the direct intragallbladder ICG injection. This narrative mini-review aims to assess the potential applications, usefulness, and limitations of intragallbladder ICG fluorescence in LC. Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy, as well as special issues regarding its use. Literature search retrieved four prospective cohort studies, three case-control studies, and one case report. In the three case-control studies selected, intragallbladder near-infrared cholangiography (NIRC) was compared with standard LC under white light, with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography (IOC). In total, 133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC. Literature includes several reports of intragallbladder ICG administration, but a standardized technique has not been established yet. Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping, overwhelming limitations of IOC including intervention and radiation exposure, as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence. Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries.

Laparoscopic subtotal cholecystectomy outcomes across a low-and middle-income country metropolitan health service.

Laparoscopic subtotal cholecystectomy (LSC) is a safe alternative for difficult cholecystectomies to prevent bile duct injury and open conversion. The primary aim was to detail the use and outcomes on LSCs. Retrospective analysis of a prospectively maintained database of laparoscopic cholecystectomy (LC). Relative clinical factors, outcomes, and 30-day follow-up between LSC and LC were compared using univariate and multivariate analyses. Six hundred and twenty four cholecystectomies were performed and 53 (8.5%) required LSC. 81.8% were fenestrating LSC. Male sex was significantly overrepresented in the LSC group (p<0.01) and patients requiring LSC were significantly older (p<0.01). Same admission cholecystectomy was associated with a higher risk of LSC (p<0.01). Patients with a history of previous surgery, preoperative ERCP, or percutaneous cholecystostomy had an increased risk of undergoing LSC (p<0.01). A necrotic gallbladder was the most significant predictor of the need for a LSC (p<0.001). A contracted gallbladder, extensive adhesions, gallbladder empyema, and severe inflammation were significant predictors of difficulty (all p<0.01). Postoperative complications occurred in 26.4% of LSC patients. There were ten (18.9%) Clavien-Dindo Grade III complications, 5.7% required ERCPs, and 9.4% required relook laparotomies. Significantly, more patients in the LSC group developed bile leaks (n=8, 15%) (p<0.001). There were two readmissions within 30days, one mortality, and no BDIs occurred in the LSC cohort. LSC provides a feasible surgical option that should be utilized in complex cholecystitis.

CVS: An Effective Strategy to Prevent Bile Duct Injury

Background: Bile duct injuries have been substantially increased after the introduction of laparoscopic cholecystectomy (LC). These are accompanied by major morbidity and mortality. Studies have shown varying degrees of success in the reduction of bile duct injury (BDI) using the Critical View of Safety (CVS) technique. The aim of this study was to see the efficacy of the CVS technique as the sole method of dissection in laparoscopic cholecystectomy. Methods: 1647 cases of LC were done between January 2012 and January 2022 for a period of 10 years in two hospitals. All were operated by the CVS dissection technique and none by the infundibular technique. Cases included acute cholecystitis, chronic cholecystitis, gangrenous cholecystitis, empyema, and Gallbladder (GB) polyp. Results: The average operating time was 42 minutes and the range was 13 to 80 minutes. In 92% of cases, all 3 criteria of CVS were achieved. In the remaining 8% cases were either converted to open or operated by a division of GB or subtotal cholecystectomy was done. There was only one case of cystic duct stump leak requiring drainage and common bile duct stenting. Conclusion: The excellent outcome of our study suggests that the CVS method will be the gold standard technique in the dissection of the gallbladder in LC. Further dissemination of the technique is necessary to improve safety in LC.

Critical View of Safety in Laparoscopic Cholecystectomy: Can it prevent bile duct injuries. An Institutional Prospective Observational Study

Critical View of Safety in Laparoscopic Cholecystectomy: Can it prevent bile duct injuries. An Institutional Prospective Observational Study

Examining the Effectiveness of Critical View of Safety (CVS) in Preventing Bile Duct Injuries During Laparoscopic Cholecystectomy

Backgroud: Gallbladder diseases typically present as gallstones, inflammation, and cancer. Cholecystectomy has long been the established surgical approach for treating cholelithiasis and cholecystitis. The Critical View of Safety (CVS) technique is employed to identify key anatomical structures precisely, namely the cystic duct and the cystic artery. As such, this study aims to evaluate the effectiveness of the CVS method in laparoscopic cholecystectomy for preventing bile duct injuries. Material and methods: The study encompassed a cohort of 70 consecutive patients diagnosed with gallbladder disease. Thorough demographic information for each patient was meticulously collected. Preoperatively, a comprehensive hematological and biochemical profile analysis was conducted. Proficient and seasoned surgeons executed all surgical procedures. Subsequently, a post-operative evaluation was carried out for all patients. Results: In our study, aberrant anatomy was identified in two patients, while 68 patients exhibited typical anatomical structures. Notably, we achieved a 100 percent success rate in obtaining the Critical View of Safety for all patients in our study. However, aberrant anatomy was encountered exclusively in those two cases, necessitating a conversion to open cholecystectomy. Conclusion: The Critical View of Safety method for ductal identification is an effective technique.

Is the Safe Cholecystectomy Technique Really Safe?

Aim: This study aims to present the results of a single surgeon's experience to demonstrate the effectiveness of the 'Critical View of Safety' (CVS) technique in preventing bile duct injuries in clinical practice. &#x0D; Method: We retrospectively reviewed the records of 899 patients who underwent cholecystectomy using the CVS technique performed by a single surgeon at the Sivas Cumhuriyet University Hospital General Surgery Department between 2018 and 2023. Ethical approval for the study was obtained. Cholecystectomy cases were scanned retrospectively. The patients' age, gender, drain placement, surgery indications, and reason for switching to open cholecystectomy were recorded. &#x0D; Results: Among the 899 patients reviewed, 312 were male (34.70%), and 587 were female (65.30%). The average age was 55.10 for males and 51,65 for females. It was determined that 7(0.77%), cases converted to open cholecystectomy. The most common indication for cholecystectomy was elective gallbladder stone removal, accounting for 47.05% of cases. No major bile duct injuries were detected..&#x0D; Conclusions: The safe cholecystectomy technique can be safely applied to avoid bile duct injuries in laparoscopic cholecystectomy.

Validation of a surgical difficulty grading system in laparoscopic cholecystectomy for acute cholecystitis.

The surgical difficulty of laparoscopic cholecystectomy (LC) for acute cholecystitis varies from case to case, and appropriate intraoperative evaluation would help prevent bile duct injury (BDI). We analyzed 178 patients who underwent LC for acute cholecystitis. Expert surgeons and trainees individually evaluated the surgical difficulty. The inter-rater agreement was analyzed using Conger's κ and Gwet's agreement coefficient (AC). Furthermore, we analyzed the predictive surgical difficulty item for performing subtotal cholecystectomy (STC). Regarding the inter-rater agreement between expert surgeons and trainees, 15 of the 17 surgical difficulty items had a Gwet's AC of 0.5 or higher, indicating "moderate" agreement or higher. Furthermore, the highest and total surgical difficulty scores were deemed "substantial" agreement. Scarring and dense fibrotic changes around the Calot's triangle area with easy bleeding with/without necrotic changes were predictive of whether STC should be performed. This surgical difficulty grading system is expected to be a tool that can be used by any surgeon with LC experience. STC should be performed to prevent BDI according to the changes around the Calot's triangle area.

Achieving Critical View of Safety via a New Technique: The Triple One (111) Technique.

Misidentification of anatomical structures is one of the most common causes of bile duct injury following laparoscopic cholecystectomy. Achieving Critical View of Safety (CVS) is a standard step in conducting safe cholecystectomy all over the world. In our institute, we achieve CVS via a unique technique called Triple One or 111 and find it very helpful and easy to achieve CVS. Moreover, the rate of conversion has also decreased while achieving CVS via this technique. The unique aspect of the Triple One technique is that by following this method, even new laparoscopic surgeons can achieve CVS very easily in difficult cases and, hence, it decreases the chances of vasculobiliary injury (VBI). This study aimed to determine how effective the Triple One technique is in achieving CVS as well as in lessening the chances of VBI. A total of 545 patients were admitted through the outpatient department, ranging in age from 30 to 70 years, with a mean of 50 years. The study comprised patients with American Society of Anaesthesiologists (ASA) I & II, acute and chronic cholecystitis, and symptomatic cholelithiasis. The study excluded patients with co-morbidities, prior abdominal procedures, and suspected complications. On the second postoperative day, all patients received their discharge papers and on the seventh postoperative day, follow-up was completed. Successful gallbladder extraction using the Triple One technique was achieved in 540 (99%) cases. The other five (1%) cases converted to open cholecystectomy because of the difficult gallbladder anatomy and extensive scarring. No VBI or bile duct injury was noted. No mortality was recorded during the study period. By incorporating CVS using the Triple One technique into our policies and curriculum, we may encourage safe cholecystectomy practices and prevent bile duct injuries.

Development of an artificial intelligence system for real-time intraoperative assessment of the Critical View of Safety in laparoscopic cholecystectomy.

The Critical View of Safety (CVS) was proposed in 1995 to prevent bile duct injury during laparoscopic cholecystectomy (LC). The achievement of CVS was evaluated subjectively. This study aimed to develop an artificial intelligence (AI) system to evaluate CVS scores in LC. AI software was developed to evaluate the achievement of CVS using an algorithm for image classification based on a deep convolutional neural network. Short clips of hepatocystic triangle dissection were converted from 72 LC videos, and 23,793 images were labeled for training data. The learning models were examined using metrics commonly used in machine learning. The mean values of precision, recall, F-measure, specificity, and overall accuracy for all the criteria of the best model were 0.971, 0.737, 0.832, 0.966, and 0.834, respectively. It took approximately 6fps to obtain scores for a single image. Using the AI system, we successfully evaluated the achievement of the CVS criteria using still images and videos of hepatocystic triangle dissection in LC. This encourages surgeons to be aware of CVS and is expected to improve surgical safety.

Development of a cross-artificial intelligence system for identifying intraoperative anatomical landmarks and surgical phases during laparoscopic cholecystectomy.

Attention to anatomical landmarks in the appropriate surgical phase is important to prevent bile duct injury (BDI) during laparoscopic cholecystectomy (LC). Therefore, we created a cross-AI system that works with two different AI algorithms simultaneously, landmark detection and phase recognition. We assessed whether landmark detection was activated in the appropriate phase by phase recognition during LC and the potential contribution of the cross-AI system in preventing BDI through a clinical feasibility study (J-SUMMIT-C-02). A prototype was designed to display landmarks during the preparation phase and Calot's triangle dissection. A prospective clinical feasibility study using the cross-AI system was performed in 20 LC cases. The primary endpoint of this study was the appropriateness of the detection timing of landmarks, which was assessed by an external evaluation committee (EEC). The secondary endpoint was the correctness of landmark detection and the contribution of cross-AI in preventing BDI, which were assessed based on the annotation and 4-point rubric questionnaire. Cross-AI-detected landmarks in 92% of the phases where the EEC considered landmarks necessary. In the questionnaire, each landmark detected by AI had high accuracy, especially the landmarks of the common bile duct and cystic duct, which were assessed at 3.78 and 3.67, respectively. In addition, the contribution to preventing BDI was relatively high at 3.65. The cross-AI system provided landmark detection at appropriate situations. The surgeons who previewed the model suggested that the landmark information provided by the cross-AI system may be effective in preventing BDI. Therefore, it is suggested that our system could help prevent BDI in practice. Trial registration University Hospital Medical Information Network Research Center Clinical Trial Registration System (UMIN000045731).

The role of fluorescent cholangiography in preventing biliary tract injury and finding bile leakage

The study investigated the clinical value of fluorescence cholangiography using indocyanine green (ICG) in laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in preventing bile duct injury (BDI) and detecting bile leakage. A total of 300 patients who underwent fluorescent navigation LC and LCBDE in the Second Department of General Surgery, Shengjing Hospital Affiliated to China Medical University from June 2020 to September 2022 were selected as the research objects for observation and analysis. There were 114 males and 186 females, and aged (50.7±14.0) years with the body mass index (BMI) of (23.6±1.6) kg/m². All 300 cases of fluorescence navigation surgery were successfully completed, of which 5 patients received fluorescence-guided LCBDE and primary suture. The results showed that the application of fluorescence cholangiography with ICG can effectively avoid and detect the occurrence of BDI and bile leakage. Meanwhile, it is reasonable to hypothesize that ICG can be used for rapid localization and the final check to prevent the recurrence of bile leakage when bile leakage is suspected in the second operation.

A prospective cohort study of operative outcomes in laparoscopic cholecystectomy using operative difficulty grade-adjusted CUSUM analysis.

The development of a learning health system requires a shift from intermittent retrospective review of outcomes to continuous data-driven understanding of surgical processes and patient outcomes. Doing so will require the routine prospective capture of high-quality structured data. This lack of structured data has been a significant impediment to the development of surgical data science1,2. Laparoscopic cholecystectomy, a high-volume procedure, represents an opportunity to address this, but application of these data will require a paradigm shift in outcome reporting. As part of a systems-wide quality-improvement programme an end-to-end perioperative electronic workflow solution was refined and implemented at Christchurch Hospital, a tertiary referral centre, in 20133. This system allows for end-to-end data capture, including wait listing, operation booking, synoptic operation note documentation, and prospective capture of surgical complications and outcomes. Coupled with this, Christchurch Hospital has undertaken a department-wide initiative to standardize processes in laparoscopic cholecystectomy to optimize outcomes and prevent bile duct injury (BDI)4. Integration of prospective data capture into the clinical workflow allows for the possibility of real-time outcome monitoring and quality improvement.

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.

Bile duct injury (BDI) continues to occur despite technological advances and improvements in surgical training over the past 2 decades. This study was conducted to audit our data on laparoscopic cholecystectomies performed over the past 2 decades to determine the role of Critical View of Safety (CVS) and proctored preceptorship in preventing BDI and postoperative complications. All patients undergoing elective laparoscopic cholecystectomy were analyzed retrospectively. The data were obtained from a prospectively maintained database from January 2004 to December 2019. Proctored preceptorship was used in all cases. Intraoperative details included the number of patients where CVS was defined, number of BDI and conversions. Postoperative outcomes, including hospital stay, morbidity, and bile duct stricture, were noted. Three thousand seven hundred twenty-six patients were included in the final analysis. Trainee surgeons performed 31.6% of surgeries and 9.5% of these surgeries were taken over by the senior surgeon. A CVS could be delineated in 96.6% of patients. The major BDI rate was only 0.05%. This study reiterates the fact that following the basic tenets of safe laparoscopic cholecystectomy, defining and confirming CVS, and following proctored preceptorship are critical in preventing major BDI.

Fluorescence cholangiography for detection of a cystic duct drained into an accessory hepatic duct: A case report

Laparoscopic cholecystectomy is a safe and standard procedure, but serious bile duct injury may occur due to anatomical anomalies of the biliary tract, especially the accessory hepatic duct. The use of intraoperative fluorescence cholangiography with indocyanine green during laparoscopic cholecystectomy can reportedly prevent bile duct injury. A 55-year-old woman with upper abdominal pain was referred to our hospital. Laboratory investigations revealed elevated leukocytes and biliary enzymes, while computed tomography demonstrated increased fatty tissue density around the gallbladder. Magnetic resonance cholangiopancreatography and drip infusion cholangiographic-computed tomography showed that the cystic duct drained into an accessory hepatic duct. Due to the diagnosis of cholelithiasis with a biliary anomaly, we performed laparoscopic cholecystectomy using fluorescence cholangiography with indocyanine green. We were able to recognize the accessory hepatic duct and cystic duct, then safely dissect the cystic duct without bile duct injury. Laparoscopic cholecystectomy is generally regarded as a safe procedure, but complications and even mortalities can arise in patients with anatomical anomalies of the biliary tract. The aid of intraoperative fluorescence cholangiography with indocyanine green allowed to recognize and identify the accessory hepatic duct and cystic duct, allowing us to operate without injury to the bile duct. Our experience supports the ease of use, safety, and effectivity of fluorescence cholangiography with indocyanine green. This may become the optimal standard technique to prevent bile duct injury.

Thinking Your Way Through a Difficult Laparoscopic Cholecystectomy: Technique for High-Quality Subtotal Cholecystectomy.

Laparoscopic subtotal cholecystectomy (LSC) is a bailout strategy to prevent bile duct injury in difficult gallbladder cases. It is associated with acceptable morbidity that is readily managed with postoperative interventions. Here we share our techniques for LSC. We begin with landmarking, which includes the line of safety, a theoretical line the sulcus of Rouvière and the junction of the cystic and hilar plates. If the fundus can be grasped, then the gallbladder is dissected off the cystic plate using the top-around approach. The gallbladder is then amputated, creating a short cuff of proximal gallbladder. This cuff can be left patent (2A) or cinched close with an ENDOLOOP (Ethicon) if it is small, ideally less than 1 cm (1A). If the fundus cannot be grasped, then an inverted T incision is made on the anterior gallbladder wall. The longitudinal incision is extended toward the fundus, and the transverse incision is extended superiorly along the cystic plate edge. Two "bunny ears" are developed and ultimately resected to excise the anterior gallbladder wall at an oblique angle while leaving the posterior wall intact (2B). If the remaining cuff is small, then it can be sutured closed against the gallbladder back wall (1B). In the setting of extensive bowel adhesion to the anterior gallbladder, we perform a fundectomy, from which we extend two incisions along the cystic plate to open the gallbladder like a clamshell. Our paper describes and illustrates our St Joseph's Health Centre institutional LSC approach and subtype classification (1A, 1B, 2A, and 2B).

Achievement of Critical View of Safety and Preoperative Characteristics: A Step Toward Acknowledging the Inflection Point

INTRODUCTION: The critical view of safety (CVS) is a surgical strategy that helps prevent bile duct injury (BDI) during laparoscopic cholecystectomy (LC). Bail-out procedure is indicated when the CVS cannot be achieved. The decision to halt the attempt of total cholecystectomy is termed inflection point. Few studies have analyzed operative difficulty as the ability to obtain the CVS, its relation to preoperative characteristics and postoperative complication. METHODS: Retrospective review of 119 patients who underwent emergency LC from March 2020 to July 2021. Patients with previous upper abdominal operation and hepatic disease were excluded. All LCs were performed by attendings. CVS was considered achieved by a 2-step review, including operative dictation and surgical video. A univariate analysis was conducted comparing the 2 groups. RESULTS: We found failure to obtain CVS in 42% of the cases; this was associated with male sex, odds ratio (OR) 2.38 (95% CI 1.13 to 5.03), BMI >35 kg/m2, OR 4.58 (95% CI 1.36 to 15.39), and a moderate/severe grade of cholecystitis OR 9.11 (95% CI 3.78 to 21.92). These patients had longer length of stay (LOS) 3.38 vs 1.68 days (p < 0.001) and higher incidence of complication, 10% vs 0% (p = 0.001), including major BDI and death (Table ). Table. - Results of the Univariate Analysis of Preoperative Characteristics for Achievement of Critical View of Safety Preoperative characteristic Failure to achieve CVS (n = 50) CVS achieved(n = 69) Odds ratio (95% CI) p Value Male sex 56% (28) 35% (24) 2.38(1.13–5.03) 0.02 Age >60 26% (13) 16% (11) 1.85(0.75–4.57) 0.18 BMI >35 kg/m2 22% (11) 6% (4) 4.58(1.36–15.39) 0.01 Moderate/severe AC (Grade II/III TG18) 82% (41) 33% (23) 9.11(3.78–21.92) <0.0001 WBC count (×103/μL) 9.59 (SD 3.37) 9.2 (SD 4.24) — 0.58 CONCLUSION: An association was found between preoperative values (male sex, BMI >35 kg/m2, and grade II/III acute cholecystitis) and failure to achieve CVS These preoperative clues may allow us to readily acknowledge the inflection point during emergency laparoscopic cholecystectomy to perform the safest surgical method. Our findings also support the association between failure of achieving CVS, increased LOS, and complication.

The Critical View of Safety in Laparoscopic Cholecystectomy: User Trends Among Residents and Consultants.

The Critical View of Safety (CVS) aims at preventing bile duct injuries (BDIs) in laparoscopic cholecystectomy (LCC). This study investigated CVS utilization among surgeons. Photos from LCCs were scored for satisfactory CVS. Rates of satisfactory CVS, BDIs, and postoperative complications among residents and consultants were compared. A lecture on CVS was given halfway through the study. The study comprised 1532 patients. Residents had higher rates of satisfactory CVS in elective LCCs compared with consultants (34.9% vs. 23.0%, P <0.001), but not in emergency LCCs (18.4% vs. 15.0%, P =0.252). No significant differences in BDIs or postoperative complications emerged between residents and consultants. After the lecture, elective LCCs were photographed more frequently (80.3% vs. 74.0%, P =0.032), but rates of satisfactory CVS, BDIs, and postoperative complications remained unchanged. Utilization of CVS can be affected by a single lecture but affecting rates of satisfactory CVS may require stronger interventions.

An additional port in difficult laparoscopic cholecystectomy for surgical safety.

Tokyo Guidelines 2018, clinical practice guidelines for acute cholangitis and cholecystitis, recommend bailout procedures to prevent bile duct injury (BDI) during laparoscopic cholecystectomy (LC) for difficult gallbladder. We first insert an additional port (AP) for difficult gallbladder that may require bailout procedures. Because the usefulness of an AP during LC is unclear, we therefore examined the efficacy of the AP during LC in this study. Data were collected from 115 patients who underwent LC for acute cholecystitis in our department. The indications for AP were excessive bleeding, scarring, and poor visual field around Calot's triangle. AP was inserted into the right middle abdomen so as not to interfere with other trocars and was used by the assistant. Surgical outcomes were evaluated based on AP use during LC. AP was inserted in 19 patients during LC (AP group). The indications for AP were excessive bleeding in nine patients, scarring around Calot's triangle in seven patients, and poor visual field around Calot's triangle in three patients. Open conversion was performed in two patients in the non-AP group. BDI occurred in one patient in the non-AP group. In patients with Difficulty Score 3, operation time was significantly shorter (P=.038) and Critical View of Safety (CVS) score was significantly higher in the AP group (P=.046). AP is useful in patients with excessive bleeding to shorten operation time and increase the CVS score. AP may be one useful option for difficult gallbladder.

Outcome of Laparoscopic Cholecystectomy in Acute Calculous Choleycystitis – Analysis of 100 cases

Introduction: Gallbladder disease is one of the most common surgical problems worldwide. About 10-15% of the adult western population has gallstone diseases . More than half a million cholecystectomies are performed per year in United States alone. Laparoscopic cholecystectomy (LC) is currently the most widely used surgical procedure for the treatment of gallstones. Aims and Objectives: To observe the cause of difficulties, the sequele , identify and find out the nature &amp; rate of per operative complications and find out the type &amp; frequency of early post-operative complications following laparoscopic cholecystectomy in acute calculous cholecystitis. Materials and Methods: This is a prospective interventional study which was conducted at Jashore Medical College Hospital &amp; some clinics of the city from Sept 2019 to Feb 2020. A total of 100 patients underwent Laparoscopic cholecystectomy for acute calculous cholecystitis within 7 days of admission. Results:Among 100 patients, 80 females &amp; 20 males with maximum age group were in the fourth decade, Laparoscopic cholecystectomy was done in 97 (97%) cases &amp; in 3(3%) cases conversion were needed, none of the patients were developed major Per &amp; postoperative complications. Peroperative complication rate was 22 (22%) with conversion was 03(3%) cases. All of the above complications were managed accordingly &amp; successfully. Conclusion: Laparoscopic Cholecystectomy is a safe, effective procedure for the early management of patients with acute calculus cholecystitis. Meticulous dissection &amp; good exposure of callot’s triangle, posterior clearance may prevent bile duct injuries. Medicine Today 2022 Vol.34(1): 39-43

Preoperative risk score to predict subtotal cholecystectomy after gallbladder drainage for acute cholecystitis: Secondary analysis of data from a multi-institutional retrospective study (CSGO-HBP-017B).

Subtotal cholecystectomy (STC) has become recognized as a "bailout procedure" to prevent bile duct injury in patients undergoing laparoscopic cholecystectomy (LC). Predictors of conversion to STC have not been identified because LC difficulty varies based on pericholecystic inflammation. We analyzed data from patients enrolled in a previously performed multi-institutional retrospective study of the optimal timing of LC after gallbladder drainage for acute cholecystitis (AC). These patients presumably had a considerable degree of pericholecystic inflammation. In total, 347 patients who underwent LC after gallbladder drainage for AC were analyzed to examine preoperative and perioperative factors predicting conversion to STC. Three hundred patients underwent total cholecystectomy (TC) and 47 underwent conversion to STC. Eastern Cooperative Oncology Group Performance Status (ECOG PS) (P< .01), severity of cholecystitis (P= .04), previous history of treatment for common bile duct stones (CBDS) (P< .01), and surgeon experience (P= .03) were significantly associated with conversion to STC. Logistic regression analyses showed that ECOG PS (odds ratio 0.2; P< .0001) and previous history of treatment for CBDS (odds ratio 0.37; P= .0073) were independent predictors of conversion to STC. Our predictive risk score using these two variables suggested that a score ≥2 could discriminate between TC and STC (P< .0001). Poor ECOG PS and previous history of treatment for CBDS were significantly associated with conversion to STC after gallbladder drainage for AC.