Detailed Abstract
[E-poster - Biliary & Pancreas (Biliary Disease/Surgery)]
[EP 132] Bailout Surgery in Unidentified Critical View of Safety Case during Laparoscopic Cholecystectomy: a Prospective Descriptive Study from Indonesia Tertiary Hospital
Arnetta Naomi Louise LALISANG 1, Nathaniel Jason ZACHARIA 1, Vania Myralda Giamour MARBUN 1, Lam SIHARDO 1, Febiansyah IBRAHIM 1, Ridho Ardi SYAIFUL 1, Wifanto Saditya Jeo JEO 1, Yarman MAZNI 1, Agi Satria PUTRANTO 1, Toar Jean Maurice LALISANG 1, Indah JAMTANI 1
1 Digestive, Surgery, Cipto Mangunkusumo National General Hospital, INDONESIA
Background : Achieving a critical view of safety (CVS) during laparoscopic cholecystectomy (LC) has commonly been proven to decrease bile duct injury (BDI). However, a safe protocol is needed for cases with undocumented CVS. This study aimed to describe a bailout surgery strategy practiced by Indonesian surgeons.
Methods : We prospectively collected laparoscopic cholecystectomy operation reports during surgery from January to October 2023 in Cipto Mangunkusumo Hospital, a tertiary hospital in Indonesia.
Results : We collected 107 laparoscopic cholecystectomy operation reports, with the CVS achievement rate at 82.2%. All procedures were undergone with the CVS technique by nine digestive attendings assisted by fellow surgeons. Of the patients, 49 (45.8%) were categorized into inflammatory groups (Parkland ≥ 3), where all 19 unachieved CVS cases belong. A top-down approach was used in all bailout cases until achieving CVS, followed by subtotal reconstructing (7/19), subtotal fenestrated (6/19), completed top-down (4/19), and conversion to open surgery (2/19). Uncontrolled bleeding was the responsible reason for converted surgery with Mirrizi type 3 and contracted gallbladder as the comorbid. We report one major bile duct injury, bile leakage, two weeks after surgery, which was treated with open repair of the common bile duct.
Conclusions : Achieving a critical view of safety is vital to proceed with a safe laparoscopic cholecystectomy. Assessing pre and intraoperative difficulties is important to choosing the course of action when CVS is not obtained. Bailout surgery shows effective and safe results for preventing intraoperative biliary injury.
Methods : We prospectively collected laparoscopic cholecystectomy operation reports during surgery from January to October 2023 in Cipto Mangunkusumo Hospital, a tertiary hospital in Indonesia.
Results : We collected 107 laparoscopic cholecystectomy operation reports, with the CVS achievement rate at 82.2%. All procedures were undergone with the CVS technique by nine digestive attendings assisted by fellow surgeons. Of the patients, 49 (45.8%) were categorized into inflammatory groups (Parkland ≥ 3), where all 19 unachieved CVS cases belong. A top-down approach was used in all bailout cases until achieving CVS, followed by subtotal reconstructing (7/19), subtotal fenestrated (6/19), completed top-down (4/19), and conversion to open surgery (2/19). Uncontrolled bleeding was the responsible reason for converted surgery with Mirrizi type 3 and contracted gallbladder as the comorbid. We report one major bile duct injury, bile leakage, two weeks after surgery, which was treated with open repair of the common bile duct.
Conclusions : Achieving a critical view of safety is vital to proceed with a safe laparoscopic cholecystectomy. Assessing pre and intraoperative difficulties is important to choosing the course of action when CVS is not obtained. Bailout surgery shows effective and safe results for preventing intraoperative biliary injury.
SESSION
E-poster
E-Session 03/21 ALL DAY