Hengqing Zhu1, Linquan Wu1,2, Rongfa Yuan1,2, Yu Wang1, Wenjun Liao1,2, Jun Lei3,4, Jianghua Shao5,6. 1. Department of General Surgery, Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China. 2. Jiangxi Province Engineering Research Center of Hepatobiliary Disease, Nanchang, China. 3. Department of General Surgery, Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China. manderly123@sina.com. 4. Jiangxi Province Engineering Research Center of Hepatobiliary Disease, Nanchang, China. manderly123@sina.com. 5. Department of General Surgery, Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China. shao5022@163.com. 6. Jiangxi Province Engineering Research Center of Hepatobiliary Disease, Nanchang, China. shao5022@163.com.
Abstract
BACKGROUND: Primary closure after laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) is a safe and effective approach for treating cholecystolithiasis with choledocholithiasis. The aim of this study was to evaluate the learning curve of performing primary closure after LC+LCBDE. METHODS: We retrospectively identified all patients who underwent primary closure after LC+LCBDE performed by a single surgeon from January 2009 to April 2015 in our institution, and analyzed preoperative, intraoperative, and postoperative data using the cumulative sum (CUSUM) analysis to evaluate the learning curve for this procedure. RESULTS: Overall, there were 390 patients. The total postoperative complications rate was 7.2%, including bile leakage in 9 (2.3%) patients and retained common bile duct stone in 3 (0.8%) patients. The CUSUM operating time (OT) learning curve was best modeled by the equation: CUSUMOT = 312.209 × procedure0.599 × e(-0.011×procedure) + 122.608 (R2 = 0.96). The learning curve was composed of two phases, phase 1 (the initial 54 patients) and phase 2 (the remaining 336 patients). A significant decrease in the OT (116.8 ± 22.4 vs. 93.8 ± 17.8 min; p < 0.001) and complication rate (16.7 vs. 5.7%; p < 0.01) including the rate of bile leakage (7.4 vs. 1.5%; p < 0.01) and retained stone (3.7 vs. 0.3%; p < 0.01) was observed between the two phases. In addition, 20 patients had conversion to open surgery. Impacted stones were independently associated with conversion, as indicated by a multivariable analysis. CONCLUSION: The data suggest that the learning curve of this procedure was achieved in approximately 54 cases. An impacted stone was the only risk factor that affected the conversion rate.
BACKGROUND: Primary closure after laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) is a safe and effective approach for treating cholecystolithiasis with choledocholithiasis. The aim of this study was to evaluate the learning curve of performing primary closure after LC+LCBDE. METHODS: We retrospectively identified all patients who underwent primary closure after LC+LCBDE performed by a single surgeon from January 2009 to April 2015 in our institution, and analyzed preoperative, intraoperative, and postoperative data using the cumulative sum (CUSUM) analysis to evaluate the learning curve for this procedure. RESULTS: Overall, there were 390 patients. The total postoperative complications rate was 7.2%, including bile leakage in 9 (2.3%) patients and retained common bile duct stone in 3 (0.8%) patients. The CUSUM operating time (OT) learning curve was best modeled by the equation: CUSUMOT = 312.209 × procedure0.599 × e(-0.011×procedure) + 122.608 (R2 = 0.96). The learning curve was composed of two phases, phase 1 (the initial 54 patients) and phase 2 (the remaining 336 patients). A significant decrease in the OT (116.8 ± 22.4 vs. 93.8 ± 17.8 min; p < 0.001) and complication rate (16.7 vs. 5.7%; p < 0.01) including the rate of bile leakage (7.4 vs. 1.5%; p < 0.01) and retained stone (3.7 vs. 0.3%; p < 0.01) was observed between the two phases. In addition, 20 patients had conversion to open surgery. Impacted stones were independently associated with conversion, as indicated by a multivariable analysis. CONCLUSION: The data suggest that the learning curve of this procedure was achieved in approximately 54 cases. An impacted stone was the only risk factor that affected the conversion rate.
Entities:
Keywords:
Cholecystolithiasis with choledocholithiasis; Common bile duct exploration; Laparoscopic cholecystectomy; Learning curve; Primary closure
Authors: Michael W Wandling; Eric S Hungness; Emily S Pavey; Jonah J Stulberg; Ben Schwab; Anthony D Yang; Michael B Shapiro; Karl Y Bilimoria; Clifford Y Ko; Avery B Nathens Journal: JAMA Surg Date: 2016-12-01 Impact factor: 14.766
Authors: Luigi Boni; Bright Huo; Laura Alberici; Claudio Ricci; Sofia Tsokani; Dimitris Mavridis; Yasser Sami Amer; Alexandros Andreou; Thomas Berriman; Gianfranco Donatelli; Nauzer Forbes; Stylianos Kapiris; Cüneyt Kayaalp; Leena Kylänpää; Pablo Parra-Membrives; Peter D Siersema; George F Black; Stavros A Antoniou Journal: Surg Endosc Date: 2022-10-13 Impact factor: 3.453