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Archive May 2019 XX, No. 5

Your Road to Safer Lap Choles

Strategies to prevent bile duct injuries during gallbladder removal.

Salvatore Docimo Jr.

Salvatore Docimo Jr., DO, FACS


IMPROVED TECHNIQUES Any technology that can nearly eliminate the risk of injury to the common bile duct structure during a laparoscopic cholecystectomy would be ideal.

For all the benefits of laparoscopic cholecystectomy, a persistent problem continues to plague one of the most commonly performed surgical procedures: bile duct injuries (BDIs). This dreaded complication can turn an otherwise routine same-day gallbladder removal into an emergency — and a medical malpractice suit. BDIs are the No. 1 litigated case against surgeons, responsible for 1 in 5 malpractice claims.

What is the frequency of BDIs? It's relatively rare — it's estimated that only 0.4% of lap chole complications results in BDIs — but that translates to about 3,000 nicked, burned or pinched bile ducts per year when you consider that surgeons laparoscopically remove 750,000 to 1 million gallbladders annually. BDIs lead to symptoms that can be painful, even deadly, if not treated. Here are tips to make a safe operation safer.

One approach toward improving safety is standardizing dissection of the gallbladder during surgery by creating a "critical view of safety" — a technique endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). SAGES suggests these 6 strategies that surgeons can employ to adopt a universal culture of safety for cholecystectomies that minimizes the risk of BDIs.

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