Department of Surgery I., Faculty of Medicine and Dentistry, University Hospital Olomouc and Palacký University Olomouc, Zdravotníků 248/7, CZ-77900, Olomouc, Czech Republic.
Institute of Health Information and Statistics of the Czech Republic, Palackého náměstí 4, CZ-12801, Prague, Czech Republic.
Langenbecks Arch Surg. 2023 Apr 20;408(1):154. doi: 10.1007/s00423-023-02897-2.
Bile duct injury (BDI) remains the most serious complication following cholecystectomy. However, the actual incidence of BDI in the Czech Republic remains unknown. Hence, we aimed to identify the incidence of major BDI requiring operative reconstruction after elective cholecystectomy in our region despite the prevailing modern 4 K Ultra HD laparoscopy and Critical View of Safety (CVS) standards implemented in daily surgical practice among the Czech population.
In the absence of a specific registry for BDI, we analysed data from The Czech National Patient Register of Reimbursed Healthcare Services, where all procedures are mandatorily recorded. We investigated 76,345 patients who were enrolled for at least a year and underwent elective cholecystectomy during the period from 2018-2021. In this cohort, we examined the incidence of major BDI following the reconstruction of the biliary tract and other complications.
A total of 76,345 elective cholecystectomies were performed during the study period, and 186 major BDIs were registered (0.24%). Most elective cholecystectomies were performed laparoscopically (84.7%), with the remaining open (15.3%). The incidence of BDI was higher in the open surgery group (150 BDI/11700 cases/1.28%) than in laparoscopic cholecystectomy (36 BDI/64645 cases/0.06%). Furthermore, the total hospital stays with BDI after reconstruction was 13.6 days. However, the majority of laparoscopic elective cholecystectomies (57,914, 89.6%) were safe and standard procedures with no complications.
Our study corroborates the findings of previous nationwide studies. Therefore, though laparoscopic cholecystectomy is reliable, the risks of BDI cannot be eliminated.
胆管损伤（BDI）仍然是胆囊切除术后最严重的并发症。然而，捷克共和国实际的 BDI 发生率尚不清楚。因此，尽管在捷克人群中，日常手术实践中普遍采用了现代 4K 超高清腹腔镜和关键安全视野（CVS）标准，但我们仍旨在确定在我们的地区，在选择性胆囊切除术后需要手术重建的主要 BDI 的发生率。
由于缺乏 BDI 的特定登记处，我们分析了捷克国家报销医疗服务患者登记处的数据，所有程序都必须在该登记处记录。我们调查了 76345 名患者，他们至少登记了一年，并在 2018 年至 2021 年期间接受了选择性胆囊切除术。在该队列中，我们检查了胆道重建后主要 BDI 的发生率以及其他并发症。
在研究期间共进行了 76345 例选择性胆囊切除术，登记了 186 例主要 BDI（0.24%）。大多数选择性胆囊切除术是腹腔镜进行的（84.7%），其余是开放性的（15.3%）。开放性手术组的 BDI 发生率更高（150 例 BDI/11700 例/1.28%），而腹腔镜胆囊切除术组为 36 例 BDI/64645 例/0.06%。此外，重建后 BDI 的总住院时间为 13.6 天。然而，大多数腹腔镜选择性胆囊切除术（57914 例，89.6%）是安全且标准的手术，没有并发症。
我们的研究与之前的全国性研究结果一致。因此，尽管腹腔镜胆囊切除术是可靠的，但 BDI 的风险无法消除。
