Retrospective Analysis of Quality Indicators of Transduodenal Endobiliar Interventions without Anaesthesia

Abstract

The objective of the research was to assess the advantages and disadvantages of transduodenal endobiliar surgeries without general anesthesia. The analysis of 1,678 hospital records of patients who underwent transduodenal endobiliar surgery was made including the average  duration of surgery, its effectiveness and the incidence of adverse cardiorespiratory events. The number of terminated procedures and subjective evaluation of the procedure by the patient and endoscopist were taken into account.

Results. There has been a growth of minimally invasive operations since 2008. The analysis indicated that endoscopists refused to perform high-risk surgery in patients with high comorbidity. Choledocholitoextraction without general anesthesia was possible only in 50-75% of cases. One of the disadvantages of the procedure was psychological efforts made by physicians. The incidence of cardiorespiratory events was 1-2%, and surgery was terminated in 12 to 32% of cases. Postoperative  mortality was 0.18%, the total mortality rate was 1.8%.

Conclusions. Endobiliar interventions without general anesthesia showed significant limitations and disadvantages. Intraoperative complications of cardiorespiratory system when performing endoscopic surgery without general anaesthesia were obsereved only in 2% of patients, however, this small number was achieved by careful selection of low-risk patients excluding those at risk of age-related complications and those having risky comorbidities. The absence of anaesthesia significantly reduces patient safety.