L Michael Brunt1, Daniel J Deziel2, Dana A Telem3, Steven M Strasberg4, Rajesh Aggarwal5, Horacio Asbun6, Jaap Bonjer7, Marian McDonald8, Adnan Alseidi9, Mike Ujiki10, Taylor S Riall11, Chet Hammill4, Carol-Anne Moulton12, Philip H Pucher13, Rowan W Parks14, Mohammed T Ansari15, Saxon Connor16, Rebecca C Dirks17, Blaire Anderson4, Maria S Altieri4, Levan Tsamalaidze18, Dimitrios Stefanidis17. 1. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. Bruntm@wustl.edu. 2. Rush University Medical Center, Chicago, IL, USA. 3. University of Michigan School of Medicine, Ann Arbor, MI, USA. 4. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. 5. Thomas Jefferson University School of Medicine, Philadelphia, PA, USA. 6. Miami Baptist Cancer Center, Miami, FL, USA. 7. VUmc University Medical Centre, Amsterdam, The Netherlands. 8. St. Luke's University and Health Network, Allentown, PA, USA. 9. Virginia Mason Medical Center, Seattle, WA, USA. 10. NorthShore University Health System, Chicago, IL, USA. 11. University of Arizona School of Medicine, Tucson, AZ, USA. 12. University of Toronto, Toronto, CA, USA. 13. Imperial College London, London, England. 14. University of Edinburgh, Edinburgh, Scotland, UK. 15. University of Ottawa, Ottawa, CA, USA. 16. University of New Zealand, Christ Church, New Zealand. 17. Indiana University School of Medicine, Indianapolis, IN, USA. 18. Tbilisi State Medical University, Tbilisi, Georgia.
Abstract
BACKGROUND: Bile duct injury (BDI) is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI. METHODS: Literature reviews were conducted for 18 key questions across six broad topics around cholecystectomy directed by a steering group and subject experts from five surgical societies (SAGES, AHPBA IHPBA, SSAT, and EAES). Evidence-based recommendations were formulated using the GRADE methodology. When evidence-based recommendations could not be made, expert opinion was documented. A number of recommendations for future research were also documented. Recommendations were presented at a consensus meeting in October 2018 and were voted on by an international panel of 25 experts with greater than 80% agreement considered consensus. RESULTS: Consensus was reached on 17 of 18 questions by the Guideline Development Group (GDG) and expert panel with high concordance from audience participation. Most recommendations were conditional due to low certainty of evidence. Strong recommendations were made for (1) use of intraoperative biliary imaging for uncertainty of anatomy or suspicion of biliary injury; and (2) referral of patients with confirmed or suspected BDI to an experienced surgeon/multispecialty hepatobiliary team. CONCLUSION: These consensus recommendations should provide guidance to surgeons, training programs, hospitals, and professional societies for strategies that have the potential to reduce BDIs and positively impact patient outcomes. Development of clinical and educational research initiatives based on these recommendations may drive further improvement in the quality of surgical care for patients undergoing cholecystectomy.
BACKGROUND:Bile duct injury (BDI) is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI. METHODS: Literature reviews were conducted for 18 key questions across six broad topics around cholecystectomy directed by a steering group and subject experts from five surgical societies (SAGES, AHPBA IHPBA, SSAT, and EAES). Evidence-based recommendations were formulated using the GRADE methodology. When evidence-based recommendations could not be made, expert opinion was documented. A number of recommendations for future research were also documented. Recommendations were presented at a consensus meeting in October 2018 and were voted on by an international panel of 25 experts with greater than 80% agreement considered consensus. RESULTS: Consensus was reached on 17 of 18 questions by the Guideline Development Group (GDG) and expert panel with high concordance from audience participation. Most recommendations were conditional due to low certainty of evidence. Strong recommendations were made for (1) use of intraoperative biliary imaging for uncertainty of anatomy or suspicion of biliary injury; and (2) referral of patients with confirmed or suspected BDI to an experienced surgeon/multispecialty hepatobiliary team. CONCLUSION: These consensus recommendations should provide guidance to surgeons, training programs, hospitals, and professional societies for strategies that have the potential to reduce BDIs and positively impact patient outcomes. Development of clinical and educational research initiatives based on these recommendations may drive further improvement in the quality of surgical care for patients undergoing cholecystectomy.
Entities:
Keywords:
Bile duct injury; Cholecystectomy; Gallstones; Laparoscopic cholecystectomy; Patient safety
Authors: Ahmad H M Nassar; Hwei J Ng; Arkadiusz Peter Wysocki; Khurram Shahzad Khan; Ines C Gil Journal: Surg Endosc Date: 2020-10-16 Impact factor: 4.584