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Should Common Bile Duct Exploration for Choledocholithiasis Be a Specialist-Only Procedure?
Hodgson, Russell; Heathcock, Daniel; Kao, Chien-Tse; Seagar, Rosemary; Tacey, Mark; Lai, Jiun Miin; Yong, Tuck Leong; Houli, Nezor; Bird, David.
Afiliación
  • Hodgson R; Division of Surgery, Northern Health, Epping, Australia.
  • Heathcock D; Department of Surgery, University of Melbourne, Epping, Australia.
  • Kao CT; Division of Surgery, Northern Health, Epping, Australia.
  • Seagar R; Division of Surgery, Northern Health, Epping, Australia.
  • Tacey M; Division of Surgery, Northern Health, Epping, Australia.
  • Lai JM; Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia.
  • Yong TL; Division of Surgery, Northern Health, Epping, Australia.
  • Houli N; Division of Surgery, Northern Health, Epping, Australia.
  • Bird D; Division of Surgery, Northern Health, Epping, Australia.
J Laparoendosc Adv Surg Tech A ; 31(7): 743-748, 2021 Jul.
Article en En | MEDLINE | ID: mdl-33913756
Background: Common bile duct exploration (CBDE) is performed uncommonly. Issues surrounding its uptake in the laparoscopic era include perceived difficulty and lack of training. We aim to determine the success of CBDE performed by "specialist" and "nonspecialist" common bile duct (CBD) surgeons to determine whether there is a substantial difference in success and safety. Methods: A 10-year retrospective audit was performed of patients undergoing CBD exploration for choledocholithiasis. Northern Health maintains an on-call available "specialist" CBD surgeon roster to aid with CBDE. Results: Five hundred fifty-one patients were identified, of which 489/551 (88.7%) patients had stones successfully cleared. Specialists had a higher success rate (90.8% versus 82.6%, P = .008), associated with a longer surgical time. Method (transcystic or transductal), approach (laparoscopic or open), and indication for operation were similar between groups. There was no significant difference in complications. To be confident of a surgeon having an 80% success rate, 70 procedures over 10 years were required, however, an "in-control" 50% success rate may only require 1 procedure per year. Conclusion: While specialist CBDE surgeons have improved success rates, nonspecialist general surgeons also have a good and comparable success rate with an equivalent complication rate. With realistic annual targets, nonspecialist CBD surgeons should be encouraged to perform CBDE in centers without specialist support.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Especialización / Laparoscopía / Conducto Colédoco / Coledocolitiasis / Cirujanos Tipo de estudio: Evaluation_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Laparoendosc Adv Surg Tech A Año: 2021 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Especialización / Laparoscopía / Conducto Colédoco / Coledocolitiasis / Cirujanos Tipo de estudio: Evaluation_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Laparoendosc Adv Surg Tech A Año: 2021 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Estados Unidos