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Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases

BACKGROUND: Laparoscopic Kasai portoenterostomy (LKPE) is performed for biliary atresia (BA). As LKPE is a technically demanding operation, a learning curve should be defined to guide training. The aim of this study was to identify the learning curve of LKPE for BA. METHODS: Metrics of perioperative...

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Autores principales: Ji, Yi, Yang, Kaiying, Zhang, Xuepeng, Chen, Siyuan, Xu, Zhicheng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260779/
https://www.ncbi.nlm.nih.gov/pubmed/30477451
http://dx.doi.org/10.1186/s12893-018-0443-y
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author Ji, Yi
Yang, Kaiying
Zhang, Xuepeng
Chen, Siyuan
Xu, Zhicheng
author_facet Ji, Yi
Yang, Kaiying
Zhang, Xuepeng
Chen, Siyuan
Xu, Zhicheng
author_sort Ji, Yi
collection PubMed
description BACKGROUND: Laparoscopic Kasai portoenterostomy (LKPE) is performed for biliary atresia (BA). As LKPE is a technically demanding operation, a learning curve should be defined to guide training. The aim of this study was to identify the learning curve of LKPE for BA. METHODS: Metrics of perioperative safety and efficiency for 100 cases of LKPE were evaluated. Outcomes were followed to 67.2 ± 12.1 months. Cumulative sum (CUSUM) analysis was used to identify inflexion point corresponding to the learning curve. Outcome measures included operative time (ORT), rate of clearance of jaundice (CJ) and survival with native liver (SNL). RESULTS: Between May 2009 and May 2013, 100 consecutive patients with BA underwent LKPE. The rate of conversion from LKPE to open Kasai portoenterostomy (OKPE), intraoperative transfusion and any perioperative complications was 11, 26 and 16%, respectively. There was no perioperative mortality. The CUSUM analysis revealed a learning curve of 50 for LKPE. Precipitous ORT reductions from an initial mean operative time of 316.3 min that was observed in the first 50 to 232.2 min of the late 50 cases (P < 0.01). Subsequently, cases 1 to 50 were considered ‘early experience’, whereas cases 51 and higher were considered as ‘late experience’ for statistical analysis. The rate of CJ and SNL was significantly higher after the early 50 cases (P < 0.05). In contrast, the rate of intraoperative transfusion, the median time of oral feeding initiated after operation, and the length of hospital stay was not different between the both groups (P > 0.05). CONCLUSIONS: In this experience, improved perioperative and postoperative parameters for LKPE were observed in the last 50 patients when compared with the first 50 patients. The dedicated training is likely to contribute to significantly shorter learning curves in future adopters.
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spelling pubmed-62607792018-12-10 Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases Ji, Yi Yang, Kaiying Zhang, Xuepeng Chen, Siyuan Xu, Zhicheng BMC Surg Research Article BACKGROUND: Laparoscopic Kasai portoenterostomy (LKPE) is performed for biliary atresia (BA). As LKPE is a technically demanding operation, a learning curve should be defined to guide training. The aim of this study was to identify the learning curve of LKPE for BA. METHODS: Metrics of perioperative safety and efficiency for 100 cases of LKPE were evaluated. Outcomes were followed to 67.2 ± 12.1 months. Cumulative sum (CUSUM) analysis was used to identify inflexion point corresponding to the learning curve. Outcome measures included operative time (ORT), rate of clearance of jaundice (CJ) and survival with native liver (SNL). RESULTS: Between May 2009 and May 2013, 100 consecutive patients with BA underwent LKPE. The rate of conversion from LKPE to open Kasai portoenterostomy (OKPE), intraoperative transfusion and any perioperative complications was 11, 26 and 16%, respectively. There was no perioperative mortality. The CUSUM analysis revealed a learning curve of 50 for LKPE. Precipitous ORT reductions from an initial mean operative time of 316.3 min that was observed in the first 50 to 232.2 min of the late 50 cases (P < 0.01). Subsequently, cases 1 to 50 were considered ‘early experience’, whereas cases 51 and higher were considered as ‘late experience’ for statistical analysis. The rate of CJ and SNL was significantly higher after the early 50 cases (P < 0.05). In contrast, the rate of intraoperative transfusion, the median time of oral feeding initiated after operation, and the length of hospital stay was not different between the both groups (P > 0.05). CONCLUSIONS: In this experience, improved perioperative and postoperative parameters for LKPE were observed in the last 50 patients when compared with the first 50 patients. The dedicated training is likely to contribute to significantly shorter learning curves in future adopters. BioMed Central 2018-11-26 /pmc/articles/PMC6260779/ /pubmed/30477451 http://dx.doi.org/10.1186/s12893-018-0443-y Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ji, Yi
Yang, Kaiying
Zhang, Xuepeng
Chen, Siyuan
Xu, Zhicheng
Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases
title Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases
title_full Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases
title_fullStr Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases
title_full_unstemmed Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases
title_short Learning curve of laparoscopic Kasai portoenterostomy for biliary atresia: report of 100 cases
title_sort learning curve of laparoscopic kasai portoenterostomy for biliary atresia: report of 100 cases
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260779/
https://www.ncbi.nlm.nih.gov/pubmed/30477451
http://dx.doi.org/10.1186/s12893-018-0443-y
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