251. Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul-de-sac or the birth pangs of a new technical framework?
- Author
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Yoshinobu Sumiyama, Henry A. Pitt, Masafumi Inomata, Wan Yee Lau, Angus C.W. Chan, Dirk J. Gouma, Kazuo Inui, Fumihiko Miura, Palepu Jagannath, Akiko Umezawa, Nobuyasu Kano, O. James Garden, Harjit Singh, Seigo Kitano, Toshiki Rikiyama, Manabu Watanabe, Yoo Seok Yoon, Koichi Hirata, Dong Sup Yoon, Itaru Endo, Eduard Jonas, Yasuhisa Mori, Ho-Seong Han, Xiao Ping Chen, Tadahiro Takada, Taizo Hibi, Tsann Long Hwang, Yukio Iwashita, Tetsuji Ohyama, Naohiro Sata, Masahiro Yoshida, Masakazu Yamamoto, Go Wakabayashi, Taizo Kimura, Christos Dervenis, Wayne Shih Wei Huang, In Seok Choi, Kenji Suzuki, Ryota Higuchi, Mariano E Giménez, John A. Windsor, Miin Fu Chen, Keita Wada, Giulio Belli, Naoki Matsumura, Atsushi Sugioka, Sheung Tat Fan, Daniel J. Deziel, Myung-Hwan Kim, Kui Hin Liau, Avinash Supe, Eduardo de Santibañes, Daniel Cherqui, Steven M. Strasberg, Kohji Okamoto, Koji Asai, Horacio J. Asbun, Hiromi Tokumura, Goro Honda, Takeyuki Misawa, Surgery, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
- Subjects
Male ,medicine.medical_specialty ,Consensus ,Delphi Technique ,Iatrogenic Disease ,education ,Taiwan ,Delphi method ,030230 surgery ,Severe fibrosis ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Surveys and Questionnaires ,medicine ,Journal Article ,Humans ,Intraoperative Complications ,Laparoscopic cholecystectomy ,computer.programming_language ,Surgeons ,Korea ,Surgical complication ,Hepatology ,business.industry ,Bile duct ,General surgery ,Gallbladder ,United States ,humanities ,Surgery ,medicine.anatomical_structure ,Cholecystectomy, Laparoscopic ,Clinical evidence ,030220 oncology & carcinogenesis ,Female ,Bile Ducts ,business ,computer ,Delphi - Abstract
BACKGROUND: Bile duct injury (BDI) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons' perceptions is scarce.METHODS: Surgeons from Japan, Korea, Taiwan, and the U.S., etc. (n = 614) participated in a questionnaire regarding their BDI experience and near-misses; and perceptions on landmarks, intraoperative findings, and surgical techniques. Respondents voted for a Delphi process and graded each item on a five-point scale. The consensus was built when ≥80% of overall responses were 4 or 5.RESULTS: Response rates for the first- and the second-round Delphi were 60.6% and 74.9%, respectively. Misidentification of local anatomy accounted for 76.2% of BDI. Final consensus was reached on: 1) Effective retraction of the gallbladder, 2) Always obtaining critical view of safety, and 3) Avoiding excessive use of electrocautery/clipping as vital procedures; and 4) Calot's triangle area and 5) Critical view of safety as important landmarks. For 6) Impacted gallstone and 7) Severe fibrosis/scarring in Calot's triangle, bail-out procedures may be indicated.CONCLUSIONS: A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BDI. This article is protected by copyright. All rights reserved.
- Published
- 2017