Reid Fletcher, MD, MPH1, Chandler Cortina, MD1, Hannah Kornfeld, MD1, Ruojia Li, MD1, Antonios Varelas1, Lauren Willoughby1, Benjamin Veenstra, MD1, Steven Bonomo, MD2. 1Rush University, 2John H. Stroger Hospital of Cook County
Introduction: The incidence of bile duct injury (BDI) during laparoscopic cholecystectomy has not changed significantly in the past 2 decades despite increased operative experience and technical refinement. We sought to evaluate factors which might predict BDI, assess how surgeons manage injuries, and to evaluate if there is a role for minimally invasive repair.
Methods: An online survey was sent to surgeons belonging to the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) via e-mail. Survey items included personal experience with BDIs, how injuries were addressed, and surgeon attitude toward minimally invasive repair of BDIs. Descriptive statistics as well as univariate and multivariate regressions were created to identify factors associated with bile duct injuries. Statistical analyses were performed using Stata 12/SE (StataCorp LLC, College Station, TX).
Results: The survey was sent to 3411 surgeons with 559 complete responses (16.5%). The mean age of respondents was 48.7 years with an average time in practice of 16.1 years. Most respondents (61.2%) had fellowship training.
Forty-seven percent of surgeons surveyed experienced a BDI in their career with 17.1% of surgeons experiencing more than one. The majority of BDIs were identified in the operating room (64.5%). Of those identified in the operating room, 66.9% were repaired immediately. When repair was undertaken immediately, 69.5% of these repairs were performed in an open technique, with 41.6% of repairs done in consultation with a senior partner. While a majority of surgeons (57.7%) felt that BDIs could theoretically be repaired laparoscopically, only 25% of those surgeons had actually done so in practice.
In multivariate logistic regression, number of years in practice was associated with an increased risk of BDI (OR 1.03, 95% CI 1.01-1.05) whereas having any type of fellowship training was associated with a decreased risk of BDI (OR 0.51, 95% CI 0.34 – 0.76). Compared with those in academic practice, surgeons in private practice were at a significantly increased risk of having experienced a BDI (OR 2.17, 95% CI 1.31 – 3.61). The number of laparoscopic cholecystectomies or advanced laparoscopic cases performed per year were both independent of risk of BDI.
Conclusion: Nearly half of those surveyed had experienced a BDI during a laparoscopic cholecystectomy. Duration of clinical practice and community/private practice setting were associated with an increased risk of BDI, while fellowship training and academic practice setting conferred a protective effect. These findings could be used to focus continuing education programs for those populations most at risk.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93679
Program Number: S002
Presentation Session: Biliary
Presentation Type: Podium