Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate: a review and a word of caution.
نویسندگان
چکیده
OBJECTIVE To compare the incidence of bile duct injuries during single incision laparoscopic cholecystectomy (SILC) in relation to the accepted historic rate of 0.4% to 0.5% for standard laparoscopic cholecystectomy (SLC). BACKGROUND Technically, SILC is more challenging than SLC. The role and benefit of SILC in patient care has yet to be defined. Bile duct injuries have been reported in several series of SILC. METHOD A comprehensive database search of MEDLINE, EMBASE, CINAHL, and PubMed Central was performed to generate all reported cases of SILC to present. The search was limited to reports of 20 or more patients based on current literature of existing SILC learning curves. Data were analyzed using the Student t test and χ analyses where appropriate. RESULTS A total of 76 candidate studies were identified; 45 studies met inclusion criteria for an aggregate total of 2626 patients. Most SILCs were performed in the absence of acute cholecystitis (90.6%). The aggregate complication rate was 4.2%, and complications were graded according to the Dindo-Clavien Classification System. Nineteen bile duct injuries were identified for a SILC-associated bile duct injury rate of 0.72%. CONCLUSIONS There seems to be an increase in the rate of bile duct injuries during SILC when compared with historic rates during SLC. Because most SILCs are performed in optimal conditions, such as lack of acute inflammation, we urge caution in applying this technique to inflamed gallbladder pathology. Controlled trials are needed before conclusions are made regarding safety of SILC.
منابع مشابه
Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate: a review and word of caution.
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عوارض مجاری صفراوی در کله سیستکتومی لاپاراسکوپیک
Background: The incidence of complications of laparoscopic cholecystectomy has increased dramatically since the introduction and widespread use of laparoscopic cholecystectomy in 1990. Bile duct injuries are among the most important complications of this approach. Methods : From January 1998 to January 2002, a total of 155 laparoscopic cholecystectomy were performed at the Loghman Medical Cent...
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To the Editor: W e read with interest the extensive literature review by Phillips et al1 about more than 2600 single incision laparoscopic (SIL) cholecystectomies. Still, large and sufficiently powered randomized controlled trials comparing conventional laparoscopic and SIL cholecystectomy are lacking (completion of the European MUSIC trial is awaited for the end of 2012). However, an emerging ...
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OBJECTIVE To review the initial results and surgical outcomes of single-incision laparoscopic cholecystectomy. DESIGN Prospective case series. SETTING A university teaching hospital and a regional hospital in Hong Kong. PATIENTS All patients undergoing single-incision laparoscopic cholecystectomy from August 2009 to March 2011. RESULTS Fifty patients underwent single-incision laparoscop...
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ورودعنوان ژورنال:
- Annals of surgery
دوره 261 3 شماره
صفحات -
تاریخ انتشار 2012