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Solve study: a study to capture global variations in practices concerning laparoscopic cholecystectomy

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Abstract

Background

There is a lack of published data on variations in practices concerning laparoscopic cholecystectomy. The purpose of this study was to capture variations in practices on a range of preoperative, perioperative, and postoperative aspects of this procedure.

Methods

A 45-item electronic survey was designed to capture global variations in practices concerning laparoscopic cholecystectomy, and disseminated through professional surgical and training organisations and social media.

Results

638 surgeons from 70 countries completed the survey. Pre-operatively only 5.6% routinely perform an endoscopy to rule out peptic ulcer disease. In the presence of preoperatively diagnosed common bile duct (CBD) stones, 85.4% (n = 545) of the surgeons would recommend an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) before surgery, while only 10.8% (n = 69) of the surgeons would perform a CBD exploration with cholecystectomy. In patients presenting with gallstone pancreatitis, 61.2% (n = 389) of the surgeons perform cholecystectomy during the same admission once pancreatitis has settled down. Approximately, 57% (n = 363) would always administer prophylactic antibiotics and 70% (n = 444) do not routinely use pharmacological DVT prophylaxis preoperatively.

Open juxta umbilical is the preferred method of pneumoperitoneum for most patients used by 64.6% of surgeons (n = 410) but in patients with advanced obesity (BMI > 35 kg/m2, only 42% (n = 268) would use this technique and only 32% (n = 203) would use this technique if the patient has had a previous laparotomy. Most surgeons (57.7%; n = 369) prefer blunt ports. Liga clips and Hem-o-loks® were used by 66% (n = 419) and 30% (n = 186) surgeons respectively for controlling cystic duct and (n = 477) 75% and (n = 125) 20% respectively for controlling cystic artery. Almost all (97.4%) surgeons felt it was important or very important to remove stones from Hartmann’s pouch if the surgeon is unable to perform a total cholecystectomy.

Conclusions

This study highlights significant variations in practices concerning various aspects of laparoscopic cholecystectomy.

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Data availability

The data used to support the findings of this study can be released upon request.

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No funding was received for this project.

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Authors and Affiliations

  1. Health Education England North East, Newcastle upon Tyne, UK

    Matta Kuzman & Prem Thambi

  2. North West Deanery, Health Education England North West, Manchester, UK

    Khalid Munir Bhatti

  3. Wirral Hospital NHS Trust: Wirral University Teaching Hospital NHS Foundation Trust, Liverpool, UK

    Islam Omar

  4. Oxford University Hospitals NHS Trust: Oxford University Hospitals NHS Foundation Trust, London, UK

    Hany Khalil

  5. Department of Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China

    Wah Yang

  6. Royal Lancaster Infirmary, Lancaster, UK

    Nader Helmy

  7. Queen Alexandra Hospital, Portsmouth, UK

    Amir Botros

  8. Princess Alexandra Hospital, Woolloongabba, Australia

    Thomas Kidd

  9. Queen Elizabeth Hospital Birmingham, Birmingham, UK

    Siobhan McKay

  10. University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK

    Altaf Awan

  11. Belfast Health and Social Care Trust, Belfast, UK

    Mark Taylor

  12. South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

    Kamal Mahawar

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Contributions

MK and KB: Methodology, Investigation, Data Curation, Formal analysis, original draft preparation. IO: Formal analysis, Discussion of The Results and Literature Review, Writing—Review & Editing, Supervision. KM: Conceptualisation, Writing—Review & Editing, Supervision. MT: Conceptualisation, Writing—Review & Editing, Supervision. All authors have seen the final manuscript and approved it.

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Correspondence to Khalid Munir Bhatti.

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Mr. Matta Kuzman, Mr. Khalid Munir Bhatti, Mr. Islam Omar, Mr. Hany Khalil, Dr. Wah Yang, Mr. Prem Thambi, Mr. Nader Helmy, Mr Amir Botros, Dr. Thomas Kidd, Ms. Siobhan McKay, Mr. Altaf Awan, Prof Mark Taylor, and Prof. Kamal Mahawar have declared no conflict of interest.

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Kuzman, M., Bhatti, K.M., Omar, I. et al. Solve study: a study to capture global variations in practices concerning laparoscopic cholecystectomy. Surg Endosc 36, 9032–9045 (2022). https://doi.org/10.1007/s00464-022-09367-8

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