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KMID : 1143920200240040469
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Annals of Hepato-Biliary-Pancreatic Surgery
2020 Volume.24 No. 4 p.469 ~ p.476
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Bile duct injury during laparoscopic cholecystectomy: An Indian e-survey
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Sharma Supriya
Behari Anu
Shukla Ratnakar
Dasari Mukteshwar
Kapoor Vinay K.
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Abstract
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Backgrounds/Aims: In the absence of national registry of laparoscopic cholecystectomy (LC) or its complications, it is impossible to determine incidence of bile duct injury (BDI) in India. We conducted an e-survey among practicing surgeons to determine prevalence and management patterns of BDI in India. Our hypothesis was that majority of surgeons would have experienced a BDI during LC despite large experience and that most surgeons who have a BDI tend to manage it themselves.
Methods: An 18-question e-survey of practicing laparoscopic surgeons in India was done.
Results: 278/727 (38%) surgeons responded. 240/278 (86%) respondents admitted to a BDI during LC and 179/230 (78%) affirmed to more than one BDI. A total of 728 BDIs were reported. 36/230 (15%) respondents experienced their first BDI even after ＞10 years of practice and 40% had their first BDI even after having performed ＞100 LCs. 161/201 (80%) of the respondents decided to manage the BDI themselves, including 56/99 (57%) non-biliary surgeons and 44/82 (54%) surgeons working in non-biliary center. 37/201 (18%) respondents admitted to having a mortality arising out of a BDI; the mortality rate of BDI was 37/728 (5%) in this survey. Only 13/201 (6%) respondents have experienced a medico-legal case related to a BDI during LC.
Conclusions: Prevalence of BDI is high in India and occurs despite adequate experience and volume. Even inexperienced non-biliary surgeons working in non-biliary centers attempt to repair the BDI themselves. BDI is associated with significant mortality but litigation rates are fortunately low in India.
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KEYWORD
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Laparoscopic cholecystectomy, Bile duct injury, E-survey, Prevalence, Bile leak
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