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Bile duct injury during laparoscopic cholecystectomy: An Indian e-survey

Annals of Hepato-Biliary-Pancreatic Surgery 2020년 24권 4호 p.469 ~ 476
Sharma Supriya, Behari Anu, Shukla Ratnakar, Dasari Mukteshwar, Kapoor Vinay K.,
소속 상세정보
 ( Sharma Supriya ) - Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Surgical Gastroenterology
 ( Behari Anu ) - Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Surgical Gastroenterology
 ( Shukla Ratnakar ) - Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Surgical Gastroenterology
 ( Dasari Mukteshwar ) - Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Surgical Gastroenterology
 ( Kapoor Vinay K. ) - Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Surgical Gastroenterology

Abstract


Backgrounds/Aims: In the absence of national registry of laparoscopic cholecystectomy (LC) or its complications, it is impossible to determine incidence of bile duct injury (BDI) in India. We conducted an e-survey among practicing surgeons to determine prevalence and management patterns of BDI in India. Our hypothesis was that majority of surgeons would have experienced a BDI during LC despite large experience and that most surgeons who have a BDI tend to manage it themselves.

Methods: An 18-question e-survey of practicing laparoscopic surgeons in India was done.

Results: 278/727 (38%) surgeons responded. 240/278 (86%) respondents admitted to a BDI during LC and 179/230 (78%) affirmed to more than one BDI. A total of 728 BDIs were reported. 36/230 (15%) respondents experienced their first BDI even after >10 years of practice and 40% had their first BDI even after having performed >100 LCs. 161/201 (80%) of the respondents decided to manage the BDI themselves, including 56/99 (57%) non-biliary surgeons and 44/82 (54%) surgeons working in non-biliary center. 37/201 (18%) respondents admitted to having a mortality arising out of a BDI; the mortality rate of BDI was 37/728 (5%) in this survey. Only 13/201 (6%) respondents have experienced a medico-legal case related to a BDI during LC.

Conclusions: Prevalence of BDI is high in India and occurs despite adequate experience and volume. Even inexperienced non-biliary surgeons working in non-biliary centers attempt to repair the BDI themselves. BDI is associated with significant mortality but litigation rates are fortunately low in India.

키워드

Laparoscopic cholecystectomy; Bile duct injury; E-survey; Prevalence; Bile leak

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