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World Journal of Surgery

, Volume 43, Issue 12, pp 3138–3152 | Cite as

Critical Appraisal of the Impact of the Systematic Adoption of Advanced Minimally Invasive Hepatobiliary and Pancreatic Surgery on the Surgical Management of Mirizzi Syndrome

  • Ye-Xin Koh
  • Pallavi Basu
  • Yi-Xin Liew
  • Jin-Yao Teo
  • Juinn-Huar Kam
  • Ser-Yee Lee
  • Peng-Chung Cheow
  • Premaraj Jeyaraj
  • Pierce K. H. Chow
  • Alexander Y. F. Chung
  • London L. P. J. Ooi
  • Chung-Yip Chan
  • Brian K. P. GohEmail author
Original Scientific Report
  • 77 Downloads

Abstract

Background

Minimally invasive surgery (MIS) for Mirizzi syndrome (MS) remains a technically challenging procedure with a high open conversion rate. We critically evaluated the impact of the systematic adoption of MI-HBP surgery on the surgical outcomes of MS.

Methods

Ninety-five patients who underwent surgery for MS were retrospectively reviewed. Systematic adoption of advanced MI-HBP surgery started in 2012. The cohort was classified into a preadoption (2002–2012) (Era 1, n = 58) and post-adoption (2013–2017) (Era 2, n = 37). Furthermore, Era 2 was divided into a cohort operated by advanced minimally invasive surgeons (AMIS) (Era 2 AMIS, n = 19) and those by other surgeons (Era 2 others, n = 19).

Results

Comparison between Era 2 and Era 1 demonstrated a significant increase in the frequency of MIS attempted (89% vs 33%, p < 0.01), increase in the use of choledochoplasty (24% vs 2%, p < 0.01), increase operation time (180 min vs 150 min, p = 0.03) and significantly lower open conversion rate (24% vs 58%, p < 0.01). Comparison between Era 2 AMIS and Era 2 others demonstrated a significantly greater adoption of MIS (100% vs 78%, p = 0.046) with lower open conversion rate (5% vs 50%, p = 0.005). Comparison between all attempted MIS cases with open procedures demonstrated a significantly higher proportion of subtotal cholecystectomies performed (40% vs 23%, p = 0.04), choledochoplasty (17% vs 2%, p = 0.04) and shorter hospital stay (4 days vs 9 days, p < 0.01).

Conclusions

Systematic adoption of advanced MI-HBP surgery allowed surgeons to perform MIS for MS more frequently and with a significantly lower open conversion rate. Patients who underwent successful MIS had the shortest hospital stay compared to patients who underwent open surgery or required open conversion.

Notes

Acknowledgement

The authors wish to thank Ms Goh Shu Ling Doreen and Ms Yee Jia Hui for their efforts in data collection and management.

Authors contributions

YXK: Acquisition, analysis, interpretation of data for the work; drafting the work; Final approval of the version; Agreement to be accountable for all aspects of the work. PB: Acquisition, analysis, interpretation of data for the work; drafting the work; Final approval of the version; Agreement to be accountable for all aspects of the work. YXL: Acquisition, analysis, interpretation of data for the work; drafting the work; Final approval of the version; Agreement to be accountable for all aspects of the work. JYT: Acquisition, interpretation of data for the work; drafting the work; Final approval of the version; Agreement to be accountable for all aspects of the work. JHK: Interpretation of data for the work; Revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SYL: Conception or design of the work; revising critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PCC: Conception or design of the work; revising critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PRJ: Conception or design of the work; revising critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PKC: Conception or design of the work; revising critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AYC: Interpretation of data for the work; revising critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LLO: Conception or design of the work; revising critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CYC: Conception or design of the work; interpretation of data for the work; revising critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BKG: Conception or design of the work; interpretation of data for the work; revising critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding

There are no sources of funding associated with this manuscript.

Compliance with ethical standards

Conflict of interest

Drs. Koh Ye Xin, Pallavi Basu, Liew YX, Teo Jin Yao, Kam Juinn Huar, Lee Ser Yee, Brian K. P. Goh, Pierce K. H. Chow, Chan Chung Yip, Alexander Chung Yaw Fui, Cheow Peng Chung, Dr Prema Raj Jeyaraj, Dr London Ooi and Ms Liew Yi Xin have no conflicts of interest or financial ties to disclose.

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Ye-Xin Koh
    • 1
  • Pallavi Basu
    • 1
  • Yi-Xin Liew
    • 2
  • Jin-Yao Teo
    • 1
  • Juinn-Huar Kam
    • 1
  • Ser-Yee Lee
    • 1
    • 3
  • Peng-Chung Cheow
    • 1
    • 3
  • Premaraj Jeyaraj
    • 1
    • 3
  • Pierce K. H. Chow
    • 1
    • 3
  • Alexander Y. F. Chung
    • 1
    • 3
  • London L. P. J. Ooi
    • 1
    • 3
  • Chung-Yip Chan
    • 1
    • 3
  • Brian K. P. Goh
    • 1
    • 3
    Email author
  1. 1.Department of Hepatopancreatobiliary and Transplantation SurgerySingapore General HospitalSingaporeSingapore
  2. 2.Department of PharmacySingapore General HospitalSingaporeSingapore
  3. 3.Duke-National University of Singapore (NUS) Medical SchoolSingaporeSingapore

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