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Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) |
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| Authors: | M. Eikermann R. Siegel I. Broeders C. Dziri A. Fingerhut C. Gutt T. Jaschinski A. Nassar A. M. Paganini D. Pieper E. Targarona M. Schrewe A. Shamiyeh M. Strik E. A. M. Neugebauer |
| Affiliation: | 1. Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Stra?e 200, 51109, Cologne, Germany 2. Department of Visceral, Vascular, and Transplantation Surgery, Faculty of Health, Witten/Herdecke University, Campus Cologne-Merheim, Cologne, Germany 3. Meander Medisch Centrum, Afdeling Chirurgie, Amersfoort, The Netherlands 4. Department B of General Surgery, H?pital Charles Nicolle, University of Tunis El Manar, Boulevard du 9 avril 1938, Tunis, 1006, Tunisia 5. First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School Greece, 115 27, Athens, Greece 6. Allgemein-, Viszeral-, Thorax- und Gef?sschirurgie, Klinikum Memmingen, Memmingen, Germany 7. BMI Ross Hall Hospital, Glasgow, UK 8. Clinica Chirurgica e Tecnologie Avanzate, Dipartimento di Chirurgia Generale, Specialità Chirurgiche e Trapianti d’Organo “Paride Stefanini”, Azienda Policlinico Umberto I, “Sapienza” Università di Roma, Rome, Italy 9. Service of Surgery, Hospital de Santpau, Autonomous University Autonomous of Barcelona, Barcelona, Spain 10. GRB-Consulting Company for Risk-Management, Klingenbergstra?e 4, 32758, Detmold, Germany 11. Ludwig Boltzmann Institute for Operative Laparoscopy, 2nd Surgical Department, Academic Teaching Hospital, AKH Linz, Linz, Austria 12. Klinik für Allgemein-, Viszeral- und Onkologische Chirurgie, HELIOS Klinikum Berlin-Buch, Berlin, Germany |
| Abstract: | BackgroundLaparoscopic cholecystectomy is one of the most common surgical procedures in Europe (and the world) and has become the standard procedure for the management of symptomatic cholelithiasis or acute cholecystitis in patients without specific contraindications. Bile duct injuries (BDI) are rare but serious complications that can occur during a laparoscopic cholecystectomy. Prevention and management of BDI has given rise to a host of publications but very few recommendations, especially in Europe.MethodsA systematic research of the literature was performed. An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. Statements and recommendations were drafted after a consensus development conference in May 2011, followed by presentation and discussion at the annual congress of the EAES held in Torino in June 2011. Finally, full guidelines were consented and adopted by the expert panel via e-mail and web conference.ResultsA total of 1,765 publications were identified through the systematic literature search and additional submission by panellists; 671 publications were selected as potentially relevant. Only 46 publications fulfilled minimal methodological criteria to support Clinical Practice Guidelines recommendations. Because the level of evidence was low for most of the studies, most statements or recommendations had to be based on consensus of opinion among the panel members. A total of 15 statements and recommendations were developed covering the following topics: classification of injuries, epidemiology, prevention, diagnosis, and management of BDI.ConclusionsBecause BDI is a rare event, it is difficult to generate evidence for prevention, diagnosis, or the management of BDI from clinical studies. Nevertheless, the panel has formulated recommendations. Due to the currently limited evidence, a European registry should be considered to collect and analyze more valid data on BDI upon which recommendations can be based. |
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