CRITICAL VIEW OF SAFETY: A PROSPECTIVE SURGICAL AND PHOTOGRAPHIC ANALYSIS IN LAPAROSCOPIC CHOLECYSTECTOMY - DOES IT HELP TO PREVENT IATROGENIC LESIONS?

Autor:	Blitzkow ACB; Universidade Federal do Paraná, Postgraduate Program in Surgical Clinic - Curitiba (PR), Brazil., Freitas ACT; Universidade Federal do Paraná, Department of Surgery - Curitiba (PR), Brazil., Coelho JCU; Universidade Federal do Paraná, Department of Surgery - Curitiba (PR), Brazil., Campos ACL; Universidade Federal do Paraná, Department of Surgery - Curitiba (PR), Brazil., Costa MARD; Universidade Federal do Paraná, Department of Surgery - Curitiba (PR), Brazil., Buffara-Junior VA; Hospital Santa Cruz - Rede D'or, Department of Surgery - Curitiba, Paraná (PR), Brazil.; Pilar Hospital, Department of Surgery - Curitiba (PR), Brazil., Matias JEF; Universidade Federal do Paraná, Department of Surgery - Curitiba (PR), Brazil.
Jazyk:	angličtina
Zdroj:	Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery [Arq Bras Cir Dig] 2024 Oct 25; Vol. 37, pp. e1827. Date of Electronic Publication: 2024 Oct 25 (Print Publication: 2024).
DOI:	10.1590/0102-6720202400034e1827
Abstrakt:	Background: The incidence of biliary duct injuries remains higher in laparoscopic cholecystectomy (LC) in comparison to open surgery. The Critical View of Safety (CVS) was introduced by Strasberg as a strategy for reducing this catastrophic complication. AIM: The aim of this study was to evaluate how often an adequate CVS is achieved during LC, the determining factors for its success, and the associated surgical outcomes. Methods: This is a prospective study. CVS photographs of all patients who underwent LC by the same surgeon between 2020 and 2023 were taken. Success in achieving CVS was analyzed by the surgeon herself and posteriorly by hepatobiliary specialists. Patients were classified into two groups: CVS achieved and CVS not achieved. Finally, multivariable logistic regression was used to examine the association between preoperatory factors and surgical complications. Results: Three hundred and nine consecutive patients were submitted to LC. There were 73.5% elective CL and 26.5% acute cholecystitis. The age ranged from 14 to 87 years, and 76.8% were female. The median body mass index was 26.7. Previous abdominal surgeries were present in 64%, and 26% were obese. The CVS was achieved in 79.9% of the patients, and there were no surgical complications in this group. The factors associated with nonachievement were acute cholecystitis (p=0.007), male sex (p=0.014), and previous surgeries (p=0.021). Three patients needed a subtotal cholecystectomy due to severe inflammation. There was no statistical correlation between the identification of CVS and surgical complications. Conclusions: The CVS is achieved in most patients. Acute cholecystitis, male sex, and previous abdominal operations are associated with difficulties in obtaining CVS.
Databáze:	MEDLINE
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