12^th Global Gastroenterologists Meeting

Bile duct Injury (BDI) continues to occur in 0.3-0.5% of Laparoscopic cholecystectomies (LC). Misidentification of ductal anatomy is the commonest cause of BDI besides local pathology and technical reasons. Since the beginning, the surgeons rely on infundibular technique for ductal identification world wide. However, it is prone to failure and an “error trap” in variable anatomy and especially in the presence of acute and chronic inflammation. Strasberg in 1995 described a method named – critical view of safety (CVS) based on three minimum criteria of dissection in hepatocysitc triangle to identify cystic duct and artery conclusively, resulting in zero BDI during LC. Although many authors have shown CVS to be effective in preventing BDI, yet significant number (0.73-1.7%) of injuries are being reported from centres advocating CVS. Therefore, does it mean CVS technique is just talked about? Or really effective and superior to infundibular technique in preventing BDI. To alienate the doubts of its feasibility and effectiveness in preventing BDI, the present prospective study was undertaken in 1340 patients having two groups, Group-A (CVS-700 patients) and Group-B (Infundibular technique -640 pts). Patients in both the groups were of similar case mix. Group-A had two surgeons (Jr. Consultant 50-100LC and Sr. Surgeon >12000LC experience) and Group B (four surgeons having >100LC experience). CVS was achieved in 98.1% of pts and there was no conversion, bile leak and BDI (group-A). Where as in Group-B- 32 conversion, 5 BDIs occurred and out of which 3 were major BDIs. The operating time taken in Group-A (approx. 90-110minutes) was significantly higher than group-B (60-80 minutes). CVS documentation by DVD recording and OT notes were found to be equally good compared to photographs. To conclude, the results of this study leave no doubt of CVS being safe, feasible and superior to infundibular technique in preventing BDI.