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Can Surgeons Reliably Identify Non-cirrhotic Liver Disease During Laparoscopic Bariatric Surgery?
Wuopio, Alexandra; Baker, Brett M; Koethe, Benjamin; Goodman, Martin D; Shin, Reuben; Bugaev, Nikolay; Nepomnayshy, Dmitry; Kim, Woon Cho; Schnelldorfer, Thomas.
Afiliación
  • Wuopio A; Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA.
  • Baker BM; Southern New Hampshire Health, Nashua, NH, USA.
  • Koethe B; Tufts Clinical and Translational Science Institute, Tufts University, and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA.
  • Goodman MD; Department of Surgery, Tufts Medical Center, Boston, MA, 02111, USA.
  • Shin R; Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA.
  • Bugaev N; Department of Surgery, Tufts Medical Center, Boston, MA, 02111, USA.
  • Nepomnayshy D; Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA.
  • Kim WC; Department of Surgery, Tufts Medical Center, Boston, MA, 02111, USA.
  • Schnelldorfer T; Department of Surgery, Tufts Medical Center, Boston, MA, 02111, USA. thomas.schnelldorfer@tufts.edu.
Obes Surg ; 34(3): 769-777, 2024 Mar.
Article en En | MEDLINE | ID: mdl-38280161
ABSTRACT

INTRODUCTION:

Identification of liver disease during bariatric operations is an important task given the patients risk for occult fatty liver disease. Surgeon's accuracy of assessing for liver disease during an operation is poorly understood. The objective was to measure surgeons' performance on intra-operative visual assessment of the liver in a simulated environment.

METHODS:

Liver images from 100 patients who underwent laparoscopic bariatric surgery and pre-operative ultrasound elastography between July 2020 and July 2021 were retrospectively evaluated. The perception of 15 surgeons regarding the degree of hepatic steatosis and fibrosis was collected in a simulated clinical environment by survey and compared to results determined by ultrasonographic exam.

RESULTS:

The surgeons' ability to correctly identify the class of steatosis and fibrosis was poor (accuracy 61% and 59%, respectively) with a very weak correlation between the surgeon's predicted class and its true class (r = 0.17 and r = 0.12, respectively). When liver disease was present, surgeons completely missed its presence in 26% and 51% of steatosis and fibrosis, respectively. Digital image processing demonstrated that surgeons subjectively classified steatosis based on the "yellowness" of the liver and fibrosis based on texture of the liver, despite neither correlating with the true degree of liver disease.

CONCLUSION:

Laparoscopic visual assessment of the liver surface for identification of non-cirrhotic liver disease was found to be an inaccurate method during laparoscopic bariatric surgery. While validation studies are needed, the results suggest the clinical need for alternative approaches.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Obesidad Mórbida / Laparoscopía / Cirugía Bariátrica / Enfermedad del Hígado Graso no Alcohólico / Cirujanos Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: Obes Surg Asunto de la revista: METABOLISMO Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Obesidad Mórbida / Laparoscopía / Cirugía Bariátrica / Enfermedad del Hígado Graso no Alcohólico / Cirujanos Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: Obes Surg Asunto de la revista: METABOLISMO Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos