Barriers to adoption of laparoscopic cholecystectomy in a county hospital in Guatemala

Jonathan B. Imran, Annie Ochoa-Hernandez, Juan Herrejon, Cesar Ortiz, Blarimir Mijangos, Tarik Madni, Sergio Huerta

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Despite international efforts to increase performance of laparoscopic cholecystectomy (LC) in rural Guatemala, the vast majority of cholecystectomies are still performed via the open cholecystectomy (OC) approach. Our goal was to explore barriers to the adoption of LC in Guatemala as well as possible mechanisms to overcome them. Methods: We reviewed 9402 cholecystectomies performed over 14 years by surgeons at the Hospital Nacional de San Benito (HNSB) in El Peten, Guatemala, with either an open or a laparoscopic approach. We conducted personal interviews with all the surgeons who perform cholecystectomies at HNSB to determine current practice and barriers to adopting LC. Results: Overall, seven general surgeons were interviewed who regularly perform cholecystectomy. Of the total number of cholecystectomies reviewed, 8440 (90%) were open and 962 (10%) were laparoscopic. The mean number of cholecystectomies performed per surgeon was 1341.1 ± 1244.9, with OC at 1205.7 ± 1194.9, and LC at 137.4 ± 188.0. Lack of formal training in laparoscopy was identified in 57% of surgeons. Lack of government funds to implement a laparoscopic program was noted by 71% of surgeons (29% felt there was insufficient ancillary staff, 29% poor allocation of hospital funding to purchase laparoscopic equipment/training). Lack of sufficient laparoscopic equipment was identified by 71% of surgeons. Conclusions: Ninety percent of cholecystectomies performed by surgeons at HNSB continue to be OC. The major limitation is the lack of funding to provide sufficient equipment or ancillary staff. The majority of surgeons preferred to perform LC if these problems could be addressed.

Original languageEnglish (US)
JournalSurgical Endoscopy
DOIs
StatePublished - Jan 1 2019

Fingerprint

Guatemala
County Hospitals
Laparoscopic Cholecystectomy
Cholecystectomy
Equipment and Supplies
Surgeons
Financial Management
Laparoscopy
Interviews

Keywords

  • Barriers
  • Cholecystectomy
  • Guatemala
  • Laparoscopic
  • Low-income
  • Rural

ASJC Scopus subject areas

  • Surgery

Cite this

Barriers to adoption of laparoscopic cholecystectomy in a county hospital in Guatemala. / Imran, Jonathan B.; Ochoa-Hernandez, Annie; Herrejon, Juan; Ortiz, Cesar; Mijangos, Blarimir; Madni, Tarik; Huerta, Sergio.

In: Surgical Endoscopy, 01.01.2019.

Research output: Contribution to journalArticle

Imran, Jonathan B. ; Ochoa-Hernandez, Annie ; Herrejon, Juan ; Ortiz, Cesar ; Mijangos, Blarimir ; Madni, Tarik ; Huerta, Sergio. / Barriers to adoption of laparoscopic cholecystectomy in a county hospital in Guatemala. In: Surgical Endoscopy. 2019.
@article{5ead6cbadf114593b3ec581d1c92e10e,
title = "Barriers to adoption of laparoscopic cholecystectomy in a county hospital in Guatemala",
abstract = "Background: Despite international efforts to increase performance of laparoscopic cholecystectomy (LC) in rural Guatemala, the vast majority of cholecystectomies are still performed via the open cholecystectomy (OC) approach. Our goal was to explore barriers to the adoption of LC in Guatemala as well as possible mechanisms to overcome them. Methods: We reviewed 9402 cholecystectomies performed over 14 years by surgeons at the Hospital Nacional de San Benito (HNSB) in El Peten, Guatemala, with either an open or a laparoscopic approach. We conducted personal interviews with all the surgeons who perform cholecystectomies at HNSB to determine current practice and barriers to adopting LC. Results: Overall, seven general surgeons were interviewed who regularly perform cholecystectomy. Of the total number of cholecystectomies reviewed, 8440 (90{\%}) were open and 962 (10{\%}) were laparoscopic. The mean number of cholecystectomies performed per surgeon was 1341.1 ± 1244.9, with OC at 1205.7 ± 1194.9, and LC at 137.4 ± 188.0. Lack of formal training in laparoscopy was identified in 57{\%} of surgeons. Lack of government funds to implement a laparoscopic program was noted by 71{\%} of surgeons (29{\%} felt there was insufficient ancillary staff, 29{\%} poor allocation of hospital funding to purchase laparoscopic equipment/training). Lack of sufficient laparoscopic equipment was identified by 71{\%} of surgeons. Conclusions: Ninety percent of cholecystectomies performed by surgeons at HNSB continue to be OC. The major limitation is the lack of funding to provide sufficient equipment or ancillary staff. The majority of surgeons preferred to perform LC if these problems could be addressed.",
keywords = "Barriers, Cholecystectomy, Guatemala, Laparoscopic, Low-income, Rural",
author = "Imran, {Jonathan B.} and Annie Ochoa-Hernandez and Juan Herrejon and Cesar Ortiz and Blarimir Mijangos and Tarik Madni and Sergio Huerta",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00464-019-06720-2",
language = "English (US)",
journal = "Surgical Endoscopy and Other Interventional Techniques",
issn = "0930-2794",
publisher = "Springer New York",

}

TY - JOUR

T1 - Barriers to adoption of laparoscopic cholecystectomy in a county hospital in Guatemala

AU - Imran, Jonathan B.

AU - Ochoa-Hernandez, Annie

AU - Herrejon, Juan

AU - Ortiz, Cesar

AU - Mijangos, Blarimir

AU - Madni, Tarik

AU - Huerta, Sergio

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Despite international efforts to increase performance of laparoscopic cholecystectomy (LC) in rural Guatemala, the vast majority of cholecystectomies are still performed via the open cholecystectomy (OC) approach. Our goal was to explore barriers to the adoption of LC in Guatemala as well as possible mechanisms to overcome them. Methods: We reviewed 9402 cholecystectomies performed over 14 years by surgeons at the Hospital Nacional de San Benito (HNSB) in El Peten, Guatemala, with either an open or a laparoscopic approach. We conducted personal interviews with all the surgeons who perform cholecystectomies at HNSB to determine current practice and barriers to adopting LC. Results: Overall, seven general surgeons were interviewed who regularly perform cholecystectomy. Of the total number of cholecystectomies reviewed, 8440 (90%) were open and 962 (10%) were laparoscopic. The mean number of cholecystectomies performed per surgeon was 1341.1 ± 1244.9, with OC at 1205.7 ± 1194.9, and LC at 137.4 ± 188.0. Lack of formal training in laparoscopy was identified in 57% of surgeons. Lack of government funds to implement a laparoscopic program was noted by 71% of surgeons (29% felt there was insufficient ancillary staff, 29% poor allocation of hospital funding to purchase laparoscopic equipment/training). Lack of sufficient laparoscopic equipment was identified by 71% of surgeons. Conclusions: Ninety percent of cholecystectomies performed by surgeons at HNSB continue to be OC. The major limitation is the lack of funding to provide sufficient equipment or ancillary staff. The majority of surgeons preferred to perform LC if these problems could be addressed.

AB - Background: Despite international efforts to increase performance of laparoscopic cholecystectomy (LC) in rural Guatemala, the vast majority of cholecystectomies are still performed via the open cholecystectomy (OC) approach. Our goal was to explore barriers to the adoption of LC in Guatemala as well as possible mechanisms to overcome them. Methods: We reviewed 9402 cholecystectomies performed over 14 years by surgeons at the Hospital Nacional de San Benito (HNSB) in El Peten, Guatemala, with either an open or a laparoscopic approach. We conducted personal interviews with all the surgeons who perform cholecystectomies at HNSB to determine current practice and barriers to adopting LC. Results: Overall, seven general surgeons were interviewed who regularly perform cholecystectomy. Of the total number of cholecystectomies reviewed, 8440 (90%) were open and 962 (10%) were laparoscopic. The mean number of cholecystectomies performed per surgeon was 1341.1 ± 1244.9, with OC at 1205.7 ± 1194.9, and LC at 137.4 ± 188.0. Lack of formal training in laparoscopy was identified in 57% of surgeons. Lack of government funds to implement a laparoscopic program was noted by 71% of surgeons (29% felt there was insufficient ancillary staff, 29% poor allocation of hospital funding to purchase laparoscopic equipment/training). Lack of sufficient laparoscopic equipment was identified by 71% of surgeons. Conclusions: Ninety percent of cholecystectomies performed by surgeons at HNSB continue to be OC. The major limitation is the lack of funding to provide sufficient equipment or ancillary staff. The majority of surgeons preferred to perform LC if these problems could be addressed.

KW - Barriers

KW - Cholecystectomy

KW - Guatemala

KW - Laparoscopic

KW - Low-income

KW - Rural

UR - http://www.scopus.com/inward/record.url?scp=85062593514&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062593514&partnerID=8YFLogxK

U2 - 10.1007/s00464-019-06720-2

DO - 10.1007/s00464-019-06720-2

M3 - Article

C2 - 30809727

AN - SCOPUS:85062593514

JO - Surgical Endoscopy and Other Interventional Techniques

JF - Surgical Endoscopy and Other Interventional Techniques

SN - 0930-2794

ER -