Ye-Xin Koh1, Pallavi Basu1, Yi-Xin Liew2, Jin-Yao Teo1, Juinn-Huar Kam1, Ser-Yee Lee1,3, Peng-Chung Cheow1,3, Premaraj Jeyaraj1,3, Pierce K H Chow1,3, Alexander Y F Chung1,3, London L P J Ooi1,3, Chung-Yip Chan1,3, Brian K P Goh4,5. 1. Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore. 2. Department of Pharmacy, Singapore General Hospital, Singapore, 169856, Singapore. 3. Duke-National University of Singapore (NUS) Medical School, Singapore, 169856, Singapore. 4. Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore. bsgkp@hotmail.com. 5. Duke-National University of Singapore (NUS) Medical School, Singapore, 169856, Singapore. bsgkp@hotmail.com.
Abstract
BACKGROUND: Minimally invasive surgery (MIS) for Mirizzi syndrome (MS) remains a technically challenging procedure with a high open conversion rate. We critically evaluated the impact of the systematic adoption of MI-HBP surgery on the surgical outcomes of MS. METHODS: Ninety-five patients who underwent surgery for MS were retrospectively reviewed. Systematic adoption of advanced MI-HBP surgery started in 2012. The cohort was classified into a preadoption (2002-2012) (Era 1, n = 58) and post-adoption (2013-2017) (Era 2, n = 37). Furthermore, Era 2 was divided into a cohort operated by advanced minimally invasive surgeons (AMIS) (Era 2 AMIS, n = 19) and those by other surgeons (Era 2 others, n = 19). RESULTS: Comparison between Era 2 and Era 1 demonstrated a significant increase in the frequency of MIS attempted (89% vs 33%, p < 0.01), increase in the use of choledochoplasty (24% vs 2%, p < 0.01), increase operation time (180 min vs 150 min, p = 0.03) and significantly lower open conversion rate (24% vs 58%, p < 0.01). Comparison between Era 2 AMIS and Era 2 others demonstrated a significantly greater adoption of MIS (100% vs 78%, p = 0.046) with lower open conversion rate (5% vs 50%, p = 0.005). Comparison between all attempted MIS cases with open procedures demonstrated a significantly higher proportion of subtotal cholecystectomies performed (40% vs 23%, p = 0.04), choledochoplasty (17% vs 2%, p = 0.04) and shorter hospital stay (4 days vs 9 days, p < 0.01). CONCLUSIONS: Systematic adoption of advanced MI-HBP surgery allowed surgeons to perform MIS for MS more frequently and with a significantly lower open conversion rate. Patients who underwent successful MIS had the shortest hospital stay compared to patients who underwent open surgery or required open conversion.
BACKGROUND: Minimally invasive surgery (MIS) for Mirizzi syndrome (MS) remains a technically challenging procedure with a high open conversion rate. We critically evaluated the impact of the systematic adoption of MI-HBP surgery on the surgical outcomes of MS. METHODS: Ninety-five patients who underwent surgery for MS were retrospectively reviewed. Systematic adoption of advanced MI-HBP surgery started in 2012. The cohort was classified into a preadoption (2002-2012) (Era 1, n = 58) and post-adoption (2013-2017) (Era 2, n = 37). Furthermore, Era 2 was divided into a cohort operated by advanced minimally invasive surgeons (AMIS) (Era 2 AMIS, n = 19) and those by other surgeons (Era 2 others, n = 19). RESULTS: Comparison between Era 2 and Era 1 demonstrated a significant increase in the frequency of MIS attempted (89% vs 33%, p < 0.01), increase in the use of choledochoplasty (24% vs 2%, p < 0.01), increase operation time (180 min vs 150 min, p = 0.03) and significantly lower open conversion rate (24% vs 58%, p < 0.01). Comparison between Era 2 AMIS and Era 2 others demonstrated a significantly greater adoption of MIS (100% vs 78%, p = 0.046) with lower open conversion rate (5% vs 50%, p = 0.005). Comparison between all attempted MIS cases with open procedures demonstrated a significantly higher proportion of subtotal cholecystectomies performed (40% vs 23%, p = 0.04), choledochoplasty (17% vs 2%, p = 0.04) and shorter hospital stay (4 days vs 9 days, p < 0.01). CONCLUSIONS: Systematic adoption of advanced MI-HBP surgery allowed surgeons to perform MIS for MS more frequently and with a significantly lower open conversion rate. Patients who underwent successful MIS had the shortest hospital stay compared to patients who underwent open surgery or required open conversion.
Authors: Brian K P Goh; Jin-Yao Teo; Ser-Yee Lee; Juinn-Huar Kam; Peng-Chung Cheow; Premaraj Jeyaraj; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung; Chung-Yip Chan Journal: Surg Endosc Date: 2017-09-15 Impact factor: 4.584
Authors: Young Erben; Luis A Benavente-Chenhalls; John M Donohue; Florencia G Que; Michael L Kendrick; Kaye M Reid-Lombardo; Michael B Farnell; David M Nagorney Journal: J Am Coll Surg Date: 2011-04-03 Impact factor: 6.113
Authors: Brian K P Goh; Chung-Yip Chan; Jen-San Wong; Ser-Yee Lee; Victor T W Lee; Peng-Chung Cheow; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung Journal: Surg Endosc Date: 2014-11-27 Impact factor: 4.584
Authors: Brian K P Goh; Jin-Yao Teo; Chung-Yip Chan; Ser-Yee Lee; Peng-Chung Cheow; Alexander Y F Chung Journal: ANZ J Surg Date: 2016-04-27 Impact factor: 1.872
Authors: Brian K P Goh; Ser-Yee Lee; Juinn-Huar Kam; Hui Ling Soh; Peng-Chung Cheow; Pierce K H Chow; London L P J Ooi; Alexander Y F Chung; Chung-Yip Chan Journal: J Minim Access Surg Date: 2018 Apr-Jun Impact factor: 1.407