DOI: http://dx.doi.org/10.18203/2349-2902.isj20210356

Laparoscopic cholecystectomy: do upper GI and lower GI surgeons have similar outcomes?

Rajesh Chidambaranath, Pradeep F. Thomas, Siu Mei Zhen, Tim Reynolds

Abstract


Background: Laparoscopic cholecystectomy is operation performed on a regular basis, regardless of surgeon’s primary specialty. Common complications include bile duct injury, bile leaks, bleeding, and bowel injury. In Tier 2 Hospitals, upper GI surgeons will manage patients with non-complex OG and HPB disease including laparoscopic cholecystectomy. The AUGSGBI proposed that laparoscopic cholecystectomy (LC) be performed by surgeons trained in upper GI surgery. NICE guidelines recommend similarly. Concentration of surgical expertise and volumes led to lesser conversions and complications. The aim was to compare the complication rates of consecutive patients undergoing laparoscopic cholecystectomy by upper and lower GI consultants in one hospital.  

Methods: This was a retrospective observational study. We collected 100 consecutive patients from a list of laparoscopic cholecystectomies performed by upper GI surgeons (UGI) and lower GI (LGI) surgeons. All complications were identified from electronic patient records. Complications were recorded according to the Clavien and Dindo system. Median length of stay (LOS) was recorded and compared between the two groups.

Results: There was no difference in between groups with respect to sex, age, length of stay or ASA grade, nor a significant difference in complication rates between surgeons of upper and lower GI surgeons.  

Conclusions: In this study in a selected group, we did not find any difference in procedure related complications between operations conducted by upper GI and lower GI surgeon groups. However, there appeared to be a higher rate of port closure related complication at the umbilicus in operations performed by the lower GI team.  


Keywords


Laparoscopic, Cholecystectomy, Upper GI, Colorectal, Outcome, Complications

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References


Duca S, Bãlã O, Al-Hajjar N, Lancu C, Puia IC, Munteanu D, et al. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB (Oxford). 2003;5(3):152-8.

The provision of services for upper gastrointestinal surgery, www.augis.com. Accessed on 20 August 2020.

Gallstone-disease. http://www.augis.org/wpcontent/ uploads/2014/05/Acute-Gallstones-Pathway-Final-Sept-2015.pdf. Accessed on 20 July 2020.

https://www.nice.org.uk/guidance/cg188

Andrews S. Does concentration of surgical expertise improve outcomes for laparoscopic cholecystectomy? 9-year audit cycle. Surgeon. 2013;11(6):309-12.

Surgery and the NHS in numbers, RCS England. https://www.rcseng.ac.uk/news-and-events/media-centre/media-background-briefings-and statistics/surgery-and-the-nhs-in-numbers/. Accessed on 20 July 2020.

NICE gallstone disease Briefing paper May 2015. https://www.nice.org.uk/guidance/qs104/documents/gallstone-disease-qs-briefing-paper2. Accessed on 20 August 2020.

Tafazal H, Spreadborough P, Zakai D, Shastri-Hurst N, Ayaani S, Hanif M. Laparoscopic cholecystectomy: a prospective cohort study assessing the impact of grade of operating surgeon on operative time and 30-day morbidity. Ann Royal Col Surg Eng. 2018;100(3):178-84.

Giger UF, Michel JM, Opitz I, Inderbitzin DT, Kocher T, Krähenbuhl L, of Laparoscopic, S.A. and Group, T.S.S.S., 2006. Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: analysis of 22,953 consecutive cases from the Swiss Association of Laparoscopic and Thoracoscopic Surgery database. J Am Col Surge. 2006;203(5)723-8.

Murphy MM, Ng SC, Simons JP, Csikesz NG, Shah SA, Tseng JF. Predictors of major complications after laparoscopic cholecystectomy: surgeon, hospital, or patient?. J Am Col Surge. 2010;211(1):73-80.

Andrews S. Does concentration of surgical expertise improve outcomes for laparoscopic cholecystectomy? 9 year audit cycle. Surgeon. 2013;11(6):309-12.

Boddy AP, Bennett JM, Ranka S, Rhodes M. Who should perform laparoscopic cholecystectomy? A 10-year audit. Surg Endosc. 2007;21(9):1492-7.