Knowledge and practices of general surgeons and residents regarding spilled gallstones lost during laparoscopic cholecystectomy: a cross sectional survey

Patient Safety in Surgery - Tập 7 - Trang 1-6 - 2013
Muhammad Sohaib Khan1, Muhammad Adil Khatri1, Muhammad Shoaib Khan1, Zakiuddin G Oonwala2
1Civil Hospital Karachi, Pakistan
2Hamdard University Hospital, Karachi, Pakistan

Tóm tắt

Gall bladder perforation, gallstone spillage and loss are commonly reported from Laparoscopic Cholecystectomy (LC). Though rare, lost gallstones can cause a variety of complications presenting variably from within 1 month to 20 years postoperatively. Our objective was to investigate knowledge and practices of surgeons and surgical residents regarding spilled gallstones lost during laparoscopic cholecystectomy. An observational, cross-sectional survey, using a questionnaire based on 13 self-answered close-ended questions, was conducted at 6 different post-graduate centers in Karachi, Pakistan. Of the 82 participants, 23 (28%) were consultant surgeons while 59 (72%) were general surgery residents. 86% of participants were aware that stones lost during LC can cause complications. Out of the 18 reported complications presented, only 20% participants identified more than 8 complications for which they can consider lost gallstones causal. 28% of participants weren’t aware about the expected postoperative duration for presentation of complications. Only 15% of our participants expected complications beyond 5 years of the procedure. 72% of participants will not convert to open cholecystectomy to retrieve lost gallstones. While 88% of participants agreed that lost gallstones should be documented in operative notes, only 70% reported that it’s actually done in practice. 55% of participants agreed to have possibility of lost gallstones as part of the informed consent but in practice it’s included according to only 31% of participants. 68% of participants believe that patients should be informed if gallstones are lost but in actual practice only 41% participants inform patients when gallstones are lost during procedure. We conclude that there is a dearth of awareness regarding diversity of complications from lost gallstones and about their variable postoperative duration of presentation. The practices involving lost gallstones management, documentation and patient information were found to vary widely. Proper awareness is imperative as it may compel surgeons to undertake all possible measures to retrieve spilled gallstones and progress towards better and standardized practices in managing lost gallstones.

Tài liệu tham khảo

Gallstones and Laparoscopic Cholecystectomy. NIH Conse Statement. 1992, 10: 1-20.http://www.ncbi.nlm.nih.gov/pubmed/1301217,

Hui TT, Giurgiu DI, Margulies DR, Takagi S, Iida A, Phillips EH: Iatrogenic gallbladder perforation during laparoscopic cholecystectomy: etiology and sequelae. Am Surg. 1999, 65: 944-948.

Memon MA, Deeik RK, Maffi TR, Fitzgibbons RJ: The outcome of unretrieved gallstones in the peritoneal cavity during laparoscopic cholecystectomy. A prospective analysis. Surg Endosc. 1999, 13: 848-857. 10.1007/s004649901118.

Diez J, Arozamena C, Gutierrez L, Bracco J, Mon A, Sanchez Almeyra R, Secchi M: Lost stones during laparoscopic cholecystectomy. HPB Surg. 1998, 11: 105-108. 10.1155/1998/95874.

Zehetner J, Shamiyeh A, Wayand W: Lost gallstones in laparoscopic cholecystectomy: all possible complications. Am J Surg. 2007, 193: 73-78. 10.1016/j.amjsurg.2006.05.015.

Röthlin MA, Schöb O, Schlumpf R, Largiadèr F: Stones spilled during cholecystectomy: a long-term liability for the patient. Surg Laparosc Endosc. 1997, 7: 432-434. 10.1097/00019509-199710000-00016.

Mullerat J, Cooper K, Box B, Soin B: The case for standardisation of the management of gallstones spilled and not retrieved at laparoscopic cholecystectomy. Ann R Coll Surg Engl. 2008, 90: 310-312.

Cacdac RG, Lakra YP: Abdominal wall sinus tract secondary to gallstones: a complication of laparoscopic cholecystectomy. J Laparoendosc Surg. 1993, 3: 509-511. 10.1089/lps.1993.3.509.

Castro MG, Alves AS, Oliveira CA, Vieira Júnior A, Vianna JL, Costa RF: Elimination of biliary stones through the urinary tract: a complication of the laparoscopic cholecystectomy. Rev Hosp Clin Fac Med Sao Paulo. 1999, 54: 209-212. 10.1590/S0041-87811999000600007.

Chanson C, Nassiopoulos K, Petropoulos P: Complications of intraperitoneal gallstones. Schweiz Med Wochenschr. 1997, 16 (127): 1323-1328.

Willekes CL, Widmann WD: Empyema from lost gallstones: a thoracic complication of laparoscopic cholecystectomy. J Laparoendosc Surg. 1996, 6: 123-126. 10.1089/lps.1996.6.123.

Bouasker I, Zoghlami A, El Ouaer MA, Khalfallah M, Samaali I, Dziri C: Parietal abscess revealing a lost gallstone 8 years after laparoscopic cholecystectomy. Tunis Med. 2010, 88: 277-279.

Van Brunt PH, Lanzafame RJ: Subhepatic inflammatory mass after laparoscopic cholecystectomy. A delayed complication of spilled gallstones. Arch Surg. 1994, 129: 882-883. 10.1001/archsurg.1994.01420320108021.

Hanna SJ, Barakat O, Watkin S: Cholelithoptysis: an unusual delayed complication of laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg. 2004, 11: 190-192.

Steerman PH, Steerman SN: Unretrieved Gallstones Presenting as a Streptococcus bovis Liver Abscess. JSLS. 2000, 4: 263-265.

Protopapas A, Milingos S, Diakomanolis E, Kioses E, Rodolakis A, Michalas S: Septic lithiasis of the pelvis. Surg Endosc. 2003, 17: 159-10.1007/s00464-002-4234-1.

Famulari C, Pirrone G, Macrì A, Crescenti F, Scuderi G, De Caridi G, Giuseppe AL: The vesical granuloma: rare and late complication of laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2001, 11: 368-371. 10.1097/00129689-200112000-00006.

Van Mierlo PJ, De Boer SY, Van Dissel JT, Arend SM: Recurrent staphylococcal bacteraemia and subhepatic abscess associated with gallstones spilled during laparoscopic cholecystectomy two years earlier. Neth J Med. 2002, 60: 177-180.

van der Lugt JC, de Graaf PW, Dallinga RJ, Stassen LP: Abscess formation due to lost stones during laparoscopic cholecystectomy. Ned Tijdschr Geneeskd. 2005, 149: 2683-2686.

Dashkovsky I, Cozacov JC: Spillage of stones from the gallbladder during laparoscopic cholecystectomy and complication of a retroperitoneal abscess mimicking gluteal abscess in elderly patients. Surg Endosc. 2002, 16: 717-

Habib E, Elhadad A: Digestive complcations of gallstones lost during laparoscopic cholecystectomy. HPB (Oxford). 2003, 5: 118-122. 10.1080/136518203100001.

Tham CH, Ng BK: Gallstone granuloma: a rare complication of laparoscopic cholecystectomy. Singapore Med J. 2001, 42: 174-175.

Helme S, Samdani T, Sinha P: Complications of spilled gallstones following laparoscopic cholecystectomy: a case report and literature overview. J Med Case Rep. 2009, 3: 8626-10.4076/1752-1947-3-8626.

Bebawi M, Wassef S, Ramcharan A, Bapat K: Incarcerated indirect inguinal hernia: a complication of spilled gallstones. JSLS. 2000, 4: 267-269.

Narreddy SR, Guleria S, Agarwal S, Svr CM, Mandal S: Recurrent abscess at site of laparoscopic cholecystectomy port due to spilled gallstones. Indian J Gastroenterol. 2001, 20: 161-

Ahmad J, McElvanna K, McKie L, Taylor M, Diamond T: Biliary complications during a decade of increased cholecystectomy rate. Ulster Med J. 2012, 81: 79-82.

Diez J, Arozamena C, Gutierrez L, Bracco J, Mon A, Sanchez Almeyra R, Secchi M: Lost Stones During Laparoscopic Cholecystectomy. HPB Surg. 1998, 11: 105-109. 10.1155/1998/95874.

Jafarey AM, Farooqui A: Informed consent in the Pakistani milieu: the physician's perspective. J Med Ethics. 2005, 31: 93-96. 10.1136/jme.2002.002220.

Jawaid M, Mushtaq A, Mukhtar S, Khan Z: Preoperative anxiety before elective surgery. Neurosci (Riyadh). 2007, 12: 145-148.

Schäfer M, Suter C, Klaiber C, Wehrli H, Frei E, Krähenbühl L: Spilled gallstones after laparoscopic cholecystectomy. A relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies. Surg Endosc. 1998, 12: 305-309. 10.1007/s004649900659.

Wauben LS, Goossens RH, Lange JF: Evaluation of Operative Notes Concerning Laparoscopic Cholecystectomy: Are Standards Being Met?. World J Surg. 2010, 34: 903-909. 10.1007/s00268-010-0422-7.

Thông tin
Thông tin xuất bản

Patient Safety in Surgery

Tập 7

1-6

Thông tin tác giả