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The critical view of safety during laparoscopic cholecystectomy: Strasberg Yes or No? An Italian Multicentre study

2020; Springer Science+Business Media; Volume: 35; Issue: 7 Linguagem: Inglês

10.1007/s00464-020-07852-6

1866-6817

Lucia Ilaria Sgaramella, Angela Gurrado, Alessandro Pasculli, Nicola De Angelis, Riccardo Memeo, Francesco Paolo Prete, Stefano Berti, Graziano Ceccarelli, Marco Rigamonti, Francesco Badessi, Nicola Solari, Marco Milone, Fausto Catena, Stefano Scabini, F Vittore, Gennaro Perrone, Carlo De Werra, Ferdinando Cafiero, Mario Testini, Gian Luca Baiocchi, Giànandrea Baldazzi, Mario Battocletti, Sergio Bertoglio, Paolo Bianco, Walter Bugiantella, Giovanni Ciaccio, Lorenzo Cobianchi, Giovanni Conzo, Michele Crespi, Michele De Rosa, Giovanna Di Meo, Ludovico Docimo, Luca Fabris, Cosimo Feleppa, Valentina Ferraro, Tommaso Fontana, Claudio Gambardella, Andrea Gennai, Francesco Guida, Laura Invernizzi, Andrea Massobrio, Fabio Medas, Luigi Monaco, G Muntoni, Mario Musella, Denise Palombo, Roberto Perinotti, Davide Pertile, Angela Pezzolla, Gianluca Piccirillo, Roberto Polastri, Roberto Ruggiero, Marco Scatizzi, Carlo Somaglino, Salvatore Tolone, Enrico Traverso, Roberta Tutino, Carlo Valduga, Michele Zuolo,

Appendicitis Diagnosis and Management

Abstract Background Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallbladder lithiasis; nevertheless, the incidence of bile duct injuries (BDI) is still high (0.3–0.8%) compared to open cholecystectomy (0.2%). In 1995, Strasberg introduced the "Critical View of Safety" (CVS) to reduce the risk of BDI. Despite its widespread use, the scientific evidence supporting this technique to prevent BDI is controversial. Methods Between March 2017 and March 2019, the data of patients submitted to laparoscopic cholecystectomy in 30 Italian surgical departments were collected on a national database. A survey was submitted to all members of Italian Digestive Pathology Society to obtain data on the preoperative workup, the surgical and postoperative management of patients and to judge, at the end of the procedure, if the isolation of the elements was performed according to the CVS. In the case of a declared critical view, iconographic documentation was obtained, finally reviewed by an external auditor. Results Data from 604 patients were analysed. The study population was divided into two groups according to the evidence (Group A; n = 11) or absence (Group B; N = 593) of BDI and perioperative bleeding. The non-use of CVS was found in 54.6% of procedures in the Group A, and 25.8% in the Group B, and evaluating the operator-related variables the execution of CVS was associated with a significantly lower incidence of BDI and intraoperative bleeding. Conclusions The CVS confirmed to be the safest technique to recognize the elements of the Calot triangle and, if correctly performed, it significantly impacted on preventing intraoperative complications. Additional educational programs on the correct application of CVS in clinical practice would be desirable to avoid extreme conditions that may require additional procedures.