Background:Cholecystectomy is considered a general surgical operation.However,general surgeons are not trained to manage severe complications such as bile duct injury(BDI)and should refer to hepatopan-creatobiliary(HPB)surgeons when difficulty arises.This study aimed to investigate the outcomes of pa-tients who had on-table HPB consults during cholecystectomy.Methods:This is an audit of 50 patients who required on-table HPB consult during cholecystectomy from 2011 to 2017.Consultations were classified as"proactive"and"reactive",where consults were made be-fore or after surgical incision,respectively.Patient demographics and perioperative details were collected.Results:The median age of the patients was 62.5 years[interquartile range(IQR)50.8-71.3 years].Eight(16％)patients had underlying HPB co-morbidity.Gallbladder wall was thickened in all patients(median 5 mm,IQR 4-7 mm),and common bile duct was of normal caliber in all patients(median 5 mm,IQR 4-6 mm).Median length of operation and length of stay were 165 min(IQR 124-209 min)and five days(IQR 3-7 days),respectively.Subtotal cholecystectomy was performed in 18(36％)patients.Forty-eight patients were initially managed by laparoscopic approach,15(31％)required open conversion;majority(9/15,60％)were initiated before on-table consult.Majority of referrals(98％)were reactive.Common rea-sons for referral included unclear anatomy or anatomical variations(30％),presence of dense adhesions and/or contracted gallbladder(18％)and impacted stones in Hartmann's pouch(16％).Three(6％)patients were referred for BDI(2 Strasberg D and 1 Strasberg E1),and two(4％)were referred for torrential bleed-ing from arterial injury(1 cystic artery and 1 right hepatic artery).Any morbidity and 30-day readmission were 22％and 6％,respectively.There was no 90-day mortality.Conclusions:Calling for help in BDI is obligatory,but in other instances is a personal choice.Calling for help prior to open conversion is lacking and this awareness should be raised.Whether surgical outcomes could be improved by early HPB consult needs to be determined by larger multicenter reports.

Kai Siang Chan;Elizabeth Hwang;Jee Keem Low;Sameer P Junnarkar;Cheong Wei Terence Huey;Vishal G Shelat

Department of General Surgery,Tan Tock Seng Hospital,308433,Singapore

国际肝胆胰疾病杂志(英文版)

[1]Kai Siang Chan;Elizabeth Hwang;Jee Keem Low;Sameer P Junnarkar;Cheong Wei Terence Huey;Vishal G Shelat-.On-table hepatopancreatobiliary surgical consults for difficult cholecystectomies:A 7-year audit)[J].国际肝胆胰疾病杂志(英文版),2022(03):273-278

hepatopancreatobiliary,consults,cholecystectomies,Cholecystectomy,hepatopan,creatobiliary,Consultations,Subtotal,referrals,Strasberg

On,table,surgical,audit,Background,considered,general,operation,However,surgeons,not,trained,severe,complications,such,bile,duct,injury,BDI,should,HPB,when,difficulty,arises,This,study,aimed,investigate,outcomes,who,had,during,cholecystectomy,Methods,patients,required,from,were,classified,proactive,reactive,where,made,after,incision,respectively,Patient,demographics,perioperative,details,collected,Results,median,was,years,interquartile,range,IQR,Eight,underlying,morbidity,Gallbladder,wall,thickened,common,normal,caliber,Median,length,stay,five,days,performed,Forty,eight,initially,managed,by,laparoscopic,approach,open,conversion,majority,initiated,before,Majority,Common,sons,included,unclear,anatomy,anatomical,variations,presence,dense,adhesions,contracted,gallbladder,impacted,stones,Hartmann,pouch,Three,referred,E1,two,torrential,bleed,arterial,cystic,artery,right,hepatic,Any,readmission,There,mortality,Conclusions,Calling,help,obligatory,but,other,instances,personal,choice,prior,lacking,this,awareness,raised,Whether,could,improved,early,needs,determined,larger,multicenter,reports

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