Evidence map›Paper›PMID 30006843›Full record

ArticleSurgical endoscopy2019

Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era.

Christopher W Mangieri, Bryan P Hendren, Matthew A Strode, Bradley C Bandera, Byron J Faler

Abstract read
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In one paragraph

Article in Surgical endoscopy, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
47citing papers in PubMed, 7 pooled it
6.6field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

47 citing papers in PubMed, 7 syntheses or guidelines pooled it, 103 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 2 institutions in 1 country.

Christopher W MangieriDwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA, USA. christopher.w.mangieri.mil@mail.mil.
Bryan P HendrenDwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA, USA.
Matthew A StrodeDwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA, USA.
Bradley C BanderaDwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA, USA.
Byron J FalerDwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA, USA.
Eisenhower Medical Center · USRoswell Park Comprehensive Cancer Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLaparoscopic cholecystectomy is the most commonly performed laparoscopic procedure. It is superior in nearly every regard compared to open cholecystectomies. The one significant aspect where the laparoscopic approach is inferior regards the association with bile duct injuries (BDI). The BDI rate with laparoscopic cholecystectomy is approximately 0.5%; nearly triple the rate compared to the open approach. We propose that 0.5% BDI rate with the laparoscopic approach is no longer accurate.

methodsThe National Surgical Quality Improvement Program (NSQIP) registry was retrospectively reviewed. All laparoscopic cholecystectomies performed between 2012 and 2016 were extracted. A total of 217,774 cases meeting inclusion criteria were analyzed. The primary data points were the overall BDI incidence rate and time of diagnosis. BDI were identified by ICD-9 and ICD-10 codes. Secondary data points were variables associated with BDI.

resultsThe BDI rate was 0.19%. 77% of cases were diagnosed after the index surgical admission. Intra-operative cholangiography (IOC) use was associated with a higher BDI rate and higher identification rate of a BDI intraoperatively (P value < 0.0001). Resident teaching cases were protective with a RR score of 0.56 (P value < 0.0001). The presence of cholecystitis increased the risk of a BDI with a RR score of 1.20 (P value < 0.0001). There was a low conversion rate of 0.04% however converted cases had a nearly hundredfold increase in BDI at 15% (P value < 0.0001).

conclusionsThe performance of laparoscopic cholecystectomies in North America is no longer associated with higher BDI rates compared to open. IOC use still is not protective against BDI, and cholecystitis continues to be a risk factor for BDI. When a cholecystectomy requires conversion from a laparoscopic to an open approach the BDI increases a hundredfold; which may raise the concern if this approach is still a safe bailout method for a difficult laparoscopic dissection.

Indexed as

Abdominal InjuriesAdultBile Duct DiseasesBile DuctsCholangiographyCholecystectomyCholecystectomy, LaparoscopicCholecystitisFemaleHumansIncidenceIntraoperative ComplicationsLaparoscopyMaleMiddle AgedNorth AmericaBDIBile duct injuryLaparoscopic cholecystectomyProcedural safety

Identifiers

PMID30006843
OpenAlexW2883046721

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.