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Introduction: The incidence of bile duct injury (BDI) during laparoscopic cholecystectomy has not changed significantly in the past 2 decades despite increased operative experience and technical refinement. We sought to evaluate surgeon-specific factors associated with BDI and to assess how surgeons manage injuries.Methods: An online survey was sent to surgeons belonging to the Society of American Gastrointestinal and Endoscopic Surgeons via e-mail. Survey items included personal experience with BDI and how injuries were addressed. Statistical analysis was performed to identify factors associated with BDI.Results: The survey was sent to 3411 surgeons with 559 complete responses (16.5%). The mean age of respondents was 48.7 years with an average time in practice of 16.1 years. Most respondents (61.2%) had fellowship training. Forty-seven percent of surgeons surveyed experienced a BDI in their career with 17.1% of surgeons experiencing multiple BDIs. The majority of BDIs were identified in the operating room (64.5%); most injuries (66.9%) were repaired immediately. When repair was undertaken immediately, 77.4% of these repairs were performed in an open technique. A majority of surgeons (57.7%) felt that BDIs could theoretically be repaired laparoscopically and 25% of those surgeons had done so in practice. In multivariate logistic regression, any type of fellowship training was associated with a decreased risk of BDI (OR 0.51, 95% CI 0.34-0.76). Compared with those in non-academic practice, surgeons in academic practice were at a significantly decreased risk of having experienced a BDI (OR 0.62, 95% CI 0.42-0.92).Conclusion: Nearly half of those surveyed, experienced a BDI during a laparoscopic cholecystectomy. Community and private practice setting were associated with an increased risk of BDI, while fellowship training and academic practice setting conferred a protective effect. A majority of surgeons felt that BDI could be repaired laparoscopically and 25% had done so in practice. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery is a significant investment for the patient and weight loss team. In some cases, this includes a requirement for pre-operative weight loss despite the lack of evidence for a correlation with successful outcomes. We sought to determine whether weight loss on a short, immediate pre-operative diet, as well as across the medical weight loss program, would correlate with 1-year outcomes of patients undergoing laparoscopic sleeve gastrectomy (LSG).Methods: All patients having a LSG between March 2013 and March 2016 were reviewed. Demographics and biometrics [weight, body mass index (BMI)] were collected at initial, day of surgery and follow-up (2 weeks, 6 weeks, 4 months, and 1 year). Pre-operative weight loss was determined both cumulative (initial to day of surgery) and for the pre-operative diet (2 weeks). Weight loss and percent excess weight loss (%EWL) were calculated and correlated at all time points.Results: A total of 127 patients were reviewed for this study. The mean %EWL at 1-year follow-up was 47 ± 18%. Weight loss achieved on a 2-week pre-operative diet did not correlate with weight outcomes at 1-year follow-up (r = 0.134, p = 0.40); however, cumulative pre-operative weight loss had a modest correlation (r = 0.443, p < 0.01). Post-operative %EWL at 4 months had the best correlation with longer term weight loss (r = 0.730, p < 0.01).Conclusions: Pre-operative performance is not a good predictor for 1-year outcomes in LSG. Better correlation was observed in %EWL at post-surgery visits. Following the patient's trajectory post-operatively may provide a window for intervention to improve weight loss. [ABSTRACT FROM AUTHOR]

Introduction: Since the widespread adoption of laparoscopic techniques in biliary surgery, the incidence of bile duct injures (BDI) has not significantly declined despite increased operative experience and recognition of the critical view of safety (CVS) method for anatomic identification. We hypothesized that operative approaches in clinical practice may vary from well-described technical recommendations. The objective of this study was to access how practicing surgeons commonly identify anatomy during laparoscopic cholecystectomy (LC).Methods: We performed a cohort study assessing practices in biliary surgery among current practicing surgeons. Surgeons belonging to the Midwest Surgical Association and the Society of American Gastrointestinal and Endoscopic Surgeons were surveyed. Items surveyed include preferred methods for cystic duct identification, recognition of the CVS, and use of intraoperative imaging.Results: In total, 374 of 849 surgeons responded. The CVS was not correctly identified by 75 % of surgeons descriptively and by 21 % of surgeons visually. 56 % of surgeons practiced the infundibular method for identification of the cystic duct; 27 % practiced the CVS method. Intraoperative cholangiography was used by 16 % and laparoscopic ultrasound by <1 %.Conclusion: A majority of surgeons preferably do not use the CVS method of identification during LC. A large percentage of practicing surgeons are unable to describe or visually identify the CVS. These results suggest an urgent need to reexamine the tenets of how LC is being taught and disseminated and present a clear target for improvement to reduce BDI. [ABSTRACT FROM AUTHOR]