Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Hospital Nacional de San Benito, El Peten, Guatemala.
Surg Endosc. 2019 Dec;33(12):4128-4132. doi: 10.1007/s00464-019-06720-2. Epub 2019 Feb 26.
Despite international efforts to increase performance of laparoscopic cholecystectomy (LC) in rural Guatemala, the vast majority of cholecystectomies are still performed via the open cholecystectomy (OC) approach. Our goal was to explore barriers to the adoption of LC in Guatemala as well as possible mechanisms to overcome them.
We reviewed 9402 cholecystectomies performed over 14 years by surgeons at the Hospital Nacional de San Benito (HNSB) in El Peten, Guatemala, with either an open or a laparoscopic approach. We conducted personal interviews with all the surgeons who perform cholecystectomies at HNSB to determine current practice and barriers to adopting LC.
Overall, seven general surgeons were interviewed who regularly perform cholecystectomy. Of the total number of cholecystectomies reviewed, 8440 (90%) were open and 962 (10%) were laparoscopic. The mean number of cholecystectomies performed per surgeon was 1341.1 ± 1244.9, with OC at 1205.7 ± 1194.9, and LC at 137.4 ± 188.0. Lack of formal training in laparoscopy was identified in 57% of surgeons. Lack of government funds to implement a laparoscopic program was noted by 71% of surgeons (29% felt there was insufficient ancillary staff, 29% poor allocation of hospital funding to purchase laparoscopic equipment/training). Lack of sufficient laparoscopic equipment was identified by 71% of surgeons.
Ninety percent of cholecystectomies performed by surgeons at HNSB continue to be OC. The major limitation is the lack of funding to provide sufficient equipment or ancillary staff. The majority of surgeons preferred to perform LC if these problems could be addressed.
尽管国际社会努力提高危地马拉农村地区腹腔镜胆囊切除术 (LC) 的水平，但绝大多数胆囊切除术仍采用开腹胆囊切除术 (OC)。我们的目标是探讨危地马拉采用 LC 的障碍，以及克服这些障碍的可能机制。
我们回顾了在危地马拉埃尔佩滕的圣贝尼托国家医院 (HNSB) 工作的外科医生在 14 年间进行的 9402 例胆囊切除术，其中 8440 例（90%）采用开腹手术，962 例（10%）采用腹腔镜手术。我们对所有在 HNSB 进行胆囊切除术的外科医生进行了个人访谈，以确定当前的实践和采用 LC 的障碍。
共有 7 名普通外科医生接受了访谈，他们定期进行胆囊切除术。在审查的所有胆囊切除术中，8440 例（90%）为开腹手术，962 例（10%）为腹腔镜手术。每位外科医生进行的胆囊切除术平均数量为 1341.1±1244.9，OC 为 1205.7±1194.9，LC 为 137.4±188.0。57%的外科医生表示缺乏腹腔镜手术的正规培训。71%的外科医生提到缺乏政府资金来实施腹腔镜项目（29%的人认为辅助人员不足，29%的人认为医院资金分配不足，无法购买腹腔镜设备/培训）。71%的外科医生表示缺乏足够的腹腔镜设备。
HNSB 的外科医生进行的 90%的胆囊切除术仍为 OC。主要限制是缺乏资金来提供足够的设备或辅助人员。如果这些问题能够得到解决，大多数外科医生更愿意进行 LC。
