Matta Kuzman1, Khalid Munir Bhatti2, Islam Omar3, Hany Khalil4, Wah Yang5, Prem Thambi1, Nader Helmy6, Amir Botros7, Thomas Kidd8, Siobhan McKay9, Altaf Awan10, Mark Taylor11, Kamal Mahawar12. 1. Health Education England North East, Newcastle upon Tyne, UK. 2. North West Deanery, Health Education England North West, Manchester, UK. drkhalidmunirbhatti@gmail.com. 3. Wirral Hospital NHS Trust: Wirral University Teaching Hospital NHS Foundation Trust, Liverpool, UK. 4. Oxford University Hospitals NHS Trust: Oxford University Hospitals NHS Foundation Trust, London, UK. 5. Department of Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China. 6. Royal Lancaster Infirmary, Lancaster, UK. 7. Queen Alexandra Hospital, Portsmouth, UK. 8. Princess Alexandra Hospital, Woolloongabba, Australia. 9. Queen Elizabeth Hospital Birmingham, Birmingham, UK. 10. University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK. 11. Belfast Health and Social Care Trust, Belfast, UK. 12. South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK.
Abstract
BACKGROUND: There is a lack of published data on variations in practices concerning laparoscopic cholecystectomy. The purpose of this study was to capture variations in practices on a range of preoperative, perioperative, and postoperative aspects of this procedure. METHODS: A 45-item electronic survey was designed to capture global variations in practices concerning laparoscopic cholecystectomy, and disseminated through professional surgical and training organisations and social media. RESULTS: 638 surgeons from 70 countries completed the survey. Pre-operatively only 5.6% routinely perform an endoscopy to rule out peptic ulcer disease. In the presence of preoperatively diagnosed common bile duct (CBD) stones, 85.4% (n = 545) of the surgeons would recommend an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) before surgery, while only 10.8% (n = 69) of the surgeons would perform a CBD exploration with cholecystectomy. In patients presenting with gallstone pancreatitis, 61.2% (n = 389) of the surgeons perform cholecystectomy during the same admission once pancreatitis has settled down. Approximately, 57% (n = 363) would always administer prophylactic antibiotics and 70% (n = 444) do not routinely use pharmacological DVT prophylaxis preoperatively. Open juxta umbilical is the preferred method of pneumoperitoneum for most patients used by 64.6% of surgeons (n = 410) but in patients with advanced obesity (BMI > 35 kg/m2, only 42% (n = 268) would use this technique and only 32% (n = 203) would use this technique if the patient has had a previous laparotomy. Most surgeons (57.7%; n = 369) prefer blunt ports. Liga clips and Hem-o-loks® were used by 66% (n = 419) and 30% (n = 186) surgeons respectively for controlling cystic duct and (n = 477) 75% and (n = 125) 20% respectively for controlling cystic artery. Almost all (97.4%) surgeons felt it was important or very important to remove stones from Hartmann's pouch if the surgeon is unable to perform a total cholecystectomy. CONCLUSIONS: This study highlights significant variations in practices concerning various aspects of laparoscopic cholecystectomy.
BACKGROUND: There is a lack of published data on variations in practices concerning laparoscopic cholecystectomy. The purpose of this study was to capture variations in practices on a range of preoperative, perioperative, and postoperative aspects of this procedure. METHODS: A 45-item electronic survey was designed to capture global variations in practices concerning laparoscopic cholecystectomy, and disseminated through professional surgical and training organisations and social media. RESULTS: 638 surgeons from 70 countries completed the survey. Pre-operatively only 5.6% routinely perform an endoscopy to rule out peptic ulcer disease. In the presence of preoperatively diagnosed common bile duct (CBD) stones, 85.4% (n = 545) of the surgeons would recommend an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) before surgery, while only 10.8% (n = 69) of the surgeons would perform a CBD exploration with cholecystectomy. In patients presenting with gallstone pancreatitis, 61.2% (n = 389) of the surgeons perform cholecystectomy during the same admission once pancreatitis has settled down. Approximately, 57% (n = 363) would always administer prophylactic antibiotics and 70% (n = 444) do not routinely use pharmacological DVT prophylaxis preoperatively. Open juxta umbilical is the preferred method of pneumoperitoneum for most patients used by 64.6% of surgeons (n = 410) but in patients with advanced obesity (BMI > 35 kg/m2, only 42% (n = 268) would use this technique and only 32% (n = 203) would use this technique if the patient has had a previous laparotomy. Most surgeons (57.7%; n = 369) prefer blunt ports. Liga clips and Hem-o-loks® were used by 66% (n = 419) and 30% (n = 186) surgeons respectively for controlling cystic duct and (n = 477) 75% and (n = 125) 20% respectively for controlling cystic artery. Almost all (97.4%) surgeons felt it was important or very important to remove stones from Hartmann's pouch if the surgeon is unable to perform a total cholecystectomy. CONCLUSIONS: This study highlights significant variations in practices concerning various aspects of laparoscopic cholecystectomy.
Authors: My Blohm; Johanna Österberg; Gabriel Sandblom; Lars Lundell; Mats Hedberg; Lars Enochsson Journal: J Gastrointest Surg Date: 2016-09-20 Impact factor: 3.452
Authors: Edwin G Rosado; Gerardo Olivella; Eduardo J Natal-Albelo; Gabriel J Echegaray; Lenny L Rivera; Carlos A Guevara; Larry M Alejandro; Arnaldo Martínez-Rivera; Norman Ramírez; Christian A Foy Journal: Geriatr Orthop Surg Rehabil Date: 2020-11-19