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Assessing the appropriate use of laparoscopic surgery for hepatobiliary diseases

  • Original article
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

Background

The range of indications for laparoscopic surgery has widened since it was first introduced. The aim of the present study was to develop standards for the appropriate use of laparoscopic surgery in patients with choledocholithiasis or cholelithiasis.

Method

We conducted a study following the RAND appropriateness method (RAM) to develop criteria for hepatobiliary laparoscopy. A panel comprised of 7 experts rated the appropriateness of a set of indications, from 1 (very inappropriate) to 9 (very appropriate). The panelists performed ratings in 2 rounds. The first round was performed independently by every expert. The second round took place during a face-to-face meeting. According to the median of panelists’ ratings and agreement criteria, every indication was classified as appropriate, uncertain, or inappropriate.

Results

In the first round, 112 (46.7%) indications were judged as appropriate, 102 (42.5%) as uncertain, and 26 (10.8%) as inappropriate. In the second round, 99 indications (48.5%) were considered as appropriate, 81 (39.7%) as uncertain, and 24 (11.8%) as inappropriate. Disagreement between panelists decreased in the second round compared with the first round. Thirteen indications were rated as disagreement (6.4%), 125 as uncertain (61.3%), and 66 as agreement (32.3%), while in the first round, the results and proportions were 44 (18.3%), 132 (55.0%), and 64 (26.7%), respectively.

Conclusions

By using RAM, the panel was able to develop detailed explicit appropriateness criteria for the proper application of hepatobiliary laparoscopy. The criteria may be used prospectively to help in making clinical decisions or retrospectively to assess the overuse of clinical procedures.

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Acknowledgments

This Project was supported by the Quality Plan for the National Health System of the Ministry for Health and Consumer Affairs. We would also like to acknowledge the great work of the following people (in alphabetic order) who so generously have devoted their time, knowledge, and wisdom to this project. In the expert panel: Dr. Rafael Bañares Cañizares (Gregorio Marañón University General Hospital, Madrid), Dr. Esteban Cugat Andorrá (Mutua de Terrassa Hospital, Barcelona), Dr. Antonio Naranjo Rodríguez (Reina Sofía University Hospital, Córdoba), Dr. Juan Ruiz Castillo (San Cecilio University Hospital, Granada), Dr. Julio Santoyo Santoyo (Carlos Haya Hospital, Malaga), Dr. Eduardo Targarona Soler (Santa Creu i Sant Pau Hospital, Barcelona), and Dr. Antonio Torres García (San Carlos Clinical Hospital, Madrid).

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Authors and Affiliations

  1. Andalusian Agency for Health Technology Assessment (AETSA), Seville, Spain

    J. M. Molina-Linde & R. Villegas-Portero

  2. University of Seville, Seville, Spain

    Juan Ramon Lacalle-Remigio

  3. Nuestra Señora de Valme University Hospital, Seville, Spain

    D. Díaz-Gómez & P. Parra-Membrives

  4. Centro Hospitalario de Alta Resolucion, Utrera, Seville, Spain

    L. Gómez-Bujedo

  5. Unidad de Bioestadistica, Departamento de Medicina Preventiva and Salud Publica, Universidad de Sevilla, Seville, Spain

    Juan Ramon Lacalle-Remigio

Authors
  1. J. M. Molina-Linde
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  2. Juan Ramon Lacalle-Remigio
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  3. R. Villegas-Portero
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  4. D. Díaz-Gómez
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  5. L. Gómez-Bujedo
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  6. P. Parra-Membrives
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Corresponding author

Correspondence to Juan Ramon Lacalle-Remigio.

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Molina-Linde, J.M., Lacalle-Remigio, J.R., Villegas-Portero, R. et al. Assessing the appropriate use of laparoscopic surgery for hepatobiliary diseases. J Hepatobiliary Pancreat Surg 16, 844–849 (2009). https://doi.org/10.1007/s00534-009-0177-4

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  • DOI: https://doi.org/10.1007/s00534-009-0177-4

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