Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul-de-sac or the birth pangs of a new technical framework?
J Hepatobiliary Pancreat Sci
; 24(11): 591-602, 2017 Nov.
Article
em En
| MEDLINE
| ID: mdl-28884962
ABSTRACT
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. Surgeons from Japan, Korea, Taiwan, and the USA, 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. Response rates for the first- and 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. A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BDI.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ductos Biliares
/
Inquéritos e Questionários
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Colecistectomia Laparoscópica
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Doença Iatrogênica
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Complicações Intraoperatórias
Tipo de estudo:
Clinical_trials
/
Guideline
Limite:
Female
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Humans
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Male
País/Região como assunto:
America do norte
/
Asia
Idioma:
En
Revista:
J Hepatobiliary Pancreat Sci
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Japão