Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)
Laparoscopic 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.
A 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.
A 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.
Because 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.
KeywordsGuidelines Laparoscopy Bile duct injury Cholecystectomy
- 1.Guidelines CoSfDTCP, Medicine Io (2011) Clinical practice guidelines we can trust. The National Academies Press, WashingtonGoogle Scholar
- 2.National Institute for Health and Clinical Excellence (NICE) (2009) The guidelines manualGoogle Scholar
- 3.Shea BJ, Grimshaw J, Wells G, Boers M, Andersson N, Hamel C, Porter A, Tugwell P, Moher D, Bouter LM (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Method 7:10Google Scholar
- 6.Gurusamy KS, Bong JJ, Fusai G, Davidson BR (2010) Methods of cystic duct occlusion during laparoscopic cholecystectomy. Cochrane Database Syst Rev CD006807Google Scholar
- 7.Gurusamy KS, Samraj K, Fusai G, Davidson BR (2008) Early versus delayed laparoscopic cholecystectomy for biliary colic. Cochrane Database Syst Rev CD007196Google Scholar
- 8.Gurusamy KS, Samraj K, Ramamoorthy R, Farouk M, Fusai G, Davidson BR (2010) Miniport versus standard ports for laparoscopic cholecystectomy. Cochrane Database Syst Rev. doi:10.1002/14651858.CD006804.pub2
- 9.Keus F, Gooszen HG, van Laarhoven CJ (2010) Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane Hepato-Biliary Group reviews. Cochrane Database Syst Rev CD008318Google Scholar
- 22.Marks J, Tacchino R, Roberts K, Onders R, Denoto G, Paraskeva P, Rivas H, Soper N, Rosemurgy A, Shah S (2011) Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 201:369–372 discussion 372-373PubMedCrossRefGoogle Scholar
- 23.Mavrogiannis C, Liatsos C, Papanikolaou IS, Karagiannis S, Galanis P, Romanos A (2006) Biliary stenting alone versus biliary stenting plus sphincterotomy for the treatment of post-laparoscopic cholecystectomy biliary leaks: a prospective randomized study. Eur J Gastroenterol Hepatol 18:405–409PubMedCrossRefGoogle Scholar
- 26.Talwar N, Pusuluri R, Arora MP, Pawar M (2006) Randomized controlled trial of conventional carbon dioxide pneumoperitoneum versus gasless technique for laparoscopic cholecystectomy. JK Sci 8:73–78Google Scholar
- 44.Costi R, Mazzeo A, Tartamella F, Manceau C, Vacher B, Valverde A (2010) Cholecystocholedocholithiasis: a case-control study comparing the short- and long-term outcomes for a “laparoscopy-first” attitude with the outcome for sequential treatment (systematic endoscopic sphincterotomy followed by laparoscopic cholecystectomy). Surg Endosc 24:51–62PubMedCrossRefGoogle Scholar
- 52.AQUA (2011) Institute for Applied Quality Improvement and Research in Health Care GmbH. German Hospital Quality Report 2010Google Scholar
- 57.Lehmann KS, Ritz JP, Wibmer A, Gellert K, Zornig C, Burghardt J, Busing M, Runkel N, Kohlhaw K, Albrecht R, Kirchner TG, Arlt G, Mall JW, Butters M, Bulian DR, Bretschneider J, Holmer C, Buhr HJ (2010) The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients. Ann Surg 252:263–270PubMedCrossRefGoogle Scholar
- 69.Machi J, Tateishi T, Oishi AJ, Furumoto NL, Oishi RH, Uchida S, Sigel B (1999) Laparoscopic ultrasonography versus operative cholangiography during laparoscopic cholecystectomy: review of the literature and a comparison with open intraoperative ultrasonography. J Am Coll Surg 188:360–367PubMedCrossRefGoogle Scholar