Background: Laparoscopic cholecystectomy (LC) is the standard treatment for cholelithiasis. However, despite improvements in technology and implementation of a safer approach, such as the critical view of safety (CVS) technique, the risk of bile duct injury (BDI) remains an issue.

Objective: To review LC cases at a large community hospital for BDIs and compare BDI rates between conventional technique and CVS timeout approaches. The authors hypothesized that there would be lower BDI rates in the CVS timeout group.

Materials and Methods: The authors conducted a retrospective study of 1,033 consecutive patients that underwent LC at the authors’ institution between November 2015 and November 2018. Based on the timeout document and operative reports, the authors classified patients into CVS timeout and no CVS (noCVS) timeout groups and compared the BDI rates and other relevant clinical outcomes.

Results: Among the 1,033 patients, 635 and 398 patients were in the noCVS timeout and CVS timeout groups, respectively. There was no significant difference in the incidence of BDI between the two groups at 1.1% versus 1.8%, respectively (p=0.375). The CVS group exhibited less preemptive conversion to open cholecystectomy, lower incidence of uncontrolled intraoperative bleeding, shorter operative time, and shorter length of hospital stay than the noCVS group. In multivariate regression analysis, operative time of more than 90 minutes was the significant independent risk factor associated with BDI, while previous biliary inflammation was marginally associated with BDI.

Conclusion: The present study failed to demonstrate the beneficial effect of CVS timeout in preventing the development of BDI. The reasons could be attributed to surgeons’ competency with their varying skills and experience, the occurrence of injury before timeout, the case selection biases, or the wrong CVS identification. Further review of the actual surgical videos may offer more clarity into the unexpected outcome.

Keywords: Bile duct injuries; Critical view of safety; Infundibular techniques; Laparoscopic cholecystectomy

DOI: 10.35755/jmedassocthai.2022.03.13277

Received 13 December 2021 | Revised 15 February 2022 | Accepted 21 February 2022