On-table hepatopancreatobiliary surgical consults for difficult cholecystectomies: A 7-year audit.

Autor: Chan KS; Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore., Hwang E; Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore., Low JK; Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore., Junnarkar SP; Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore., Huey CWT; Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore., Shelat VG; Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore. Electronic address: vishal_g_shelat@ttsh.com.sg.
Jazyk: angličtina
Zdroj: Hepatobiliary & pancreatic diseases international : HBPD INT [Hepatobiliary Pancreat Dis Int] 2022 Jun; Vol. 21 (3), pp. 273-278. Date of Electronic Publication: 2022 Mar 21.
DOI: 10.1016/j.hbpd.2022.03.008
Abstrakt: Background: Cholecystectomy is considered a general surgical operation. However, general surgeons are not trained to manage severe complications such as bile duct injury (BDI) and should refer to hepatopancreatobiliary (HPB) surgeons when difficulty arises. This study aimed to investigate the outcomes of patients who had on-table HPB consults during cholecystectomy.
Methods: This is an audit of 50 patients who required on-table HPB consult during cholecystectomy from 2011 to 2017. Consultations were classified as "proactive" and "reactive", where consults were made before or after surgical incision, respectively. Patient demographics and perioperative details were collected.
Results: The median age of the patients was 62.5 years [interquartile range (IQR) 50.8-71.3 years]. Eight (16%) patients had underlying HPB co-morbidity. Gallbladder wall was thickened in all patients (median 5 mm, IQR 4-7 mm), and common bile duct was of normal caliber in all patients (median 5 mm, IQR 4-6 mm). Median length of operation and length of stay were 165 min (IQR 124-209 min) and five days (IQR 3-7 days), respectively. Subtotal cholecystectomy was performed in 18 (36%) patients. Forty-eight patients were initially managed by laparoscopic approach, 15 (31%) required open conversion; majority (9/15, 60%) were initiated before on-table consult. Majority of referrals (98%) were reactive. Common reasons for referral included unclear anatomy or anatomical variations (30%), presence of dense adhesions and/or contracted gallbladder (18%) and impacted stones in Hartmann's pouch (16%). Three (6%) patients were referred for BDI (2 Strasberg D and 1 Strasberg E1), and two (4%) were referred for torrential bleeding from arterial injury (1 cystic artery and 1 right hepatic artery). Any morbidity and 30-day readmission were 22% and 6%, respectively. There was no 90-day mortality.
Conclusions: Calling for help in BDI is obligatory, but in other instances is a personal choice. Calling for help prior to open conversion is lacking and this awareness should be raised. Whether surgical outcomes could be improved by early HPB consult needs to be determined by larger multicenter reports.
(Copyright © 2022. Published by Elsevier B.V.)
Databáze: MEDLINE
Externí odkaz: