Surgical Endoscopy

, Volume 26, Issue 11, pp 3003–3039 | Cite as

Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

  • 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
Guidelines

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Guidelines Laparoscopy Bile duct injury Cholecystectomy 

References

  1. 1.
    Guidelines CoSfDTCP, Medicine Io (2011) Clinical practice guidelines we can trust. The National Academies Press, WashingtonGoogle Scholar
  2. 2.
    National Institute for Health and Clinical Excellence (NICE) (2009) The guidelines manualGoogle Scholar
  3. 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
  4. 4.
    Shea BJ, Hamel C, Wells G, Bouter LM, Kristjansson E, Grimshaw J, Henry D, Boers M (2009) AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol 62:1013–1020PubMedCrossRefGoogle Scholar
  5. 5.
    Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR (2010) Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 97:141–150PubMedCrossRefGoogle Scholar
  6. 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. 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. 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. 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
  10. 10.
    Bahram M, Gaballa G (2010) The value of pre-operative magnetic resonance cholangiopancreatography (MRCP) in management of patients with gall stones. Int J Surg 8:342–345PubMedCrossRefGoogle Scholar
  11. 11.
    Bessa SS, Al-Fayoumi TA, Katri KM, Awad AT (2008) Clipless laparoscopic cholecystectomy by ultrasonic dissection. J Laparoendosc Adv Surg Tech A 18:593–598PubMedCrossRefGoogle Scholar
  12. 12.
    Calik A, Topaloglu S, Topcu S, Turkyilmaz S, Kucuktulu U, Piskin B (2007) Routine intraoperative aspiration of gallbladder during laparoscopic cholecystectomy. Surg Endosc 21:1578–1581PubMedCrossRefGoogle Scholar
  13. 13.
    Gupta A, Agarwal PN, Kant R, Malik V (2004) Evaluation of fundus-first laparoscopic cholecystectomy. JSLS 8:255–258PubMedGoogle Scholar
  14. 14.
    Harju J, Kokki H, Paakkonen M, Karjalainen K, Eskelinen M (2010) Feasibility of minilaparotomy versus laparoscopic cholecystectomy for day surgery: a prospective randomised study. Scand J Surg 99:132–136PubMedGoogle Scholar
  15. 15.
    Jarhult J (2005) Is preoperative evaluation of the biliary tree necessary in uncomplicated gallstone disease? Results of a randomized trial. Scand J Surg 94:31–33PubMedGoogle Scholar
  16. 16.
    Kato K, Kasai S, Matsuda M, Onodera K, Kato J, Imai M, Mito M, Saito T (1996) A new technique for laparoscopic cholecystectomy—retrograde laparoscopic cholecystectomy: an analysis of 81 cases. Endoscopy 28:356–359PubMedCrossRefGoogle Scholar
  17. 17.
    Katsinelos P, Kountouras J, Paroutoglou G, Chatzimavroudis G, Germanidis G, Zavos C, Pilpilidis I, Paikos D, Papaziogas B (2008) A comparative study of 10-Fr vs. 7-Fr straight plastic stents in the treatment of postcholecystectomy bile leak. Surg Endosc 22:101–106PubMedCrossRefGoogle Scholar
  18. 18.
    Khan OA, Balaji S, Branagan G, Bennett DH, Davies N (2011) Randomized clinical trial of routine on-table cholangiography during laparoscopic cholecystectomy. Br J Surg 98:362–367PubMedCrossRefGoogle Scholar
  19. 19.
    Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E (1998) Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 351:321–325PubMedCrossRefGoogle Scholar
  20. 20.
    Kumar M, Agrawal CS, Gupta RK (2007) Three-port versus standard four-port laparoscopic cholecystectomy: a randomized controlled clinical trial in a community-based teaching hospital in eastern Nepal. JSLS 11:358–362PubMedGoogle Scholar
  21. 21.
    Leida Z, Ping B, Shuguang W, Yu H (2008) A randomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy. Surg Endosc 22:1595–1600PubMedCrossRefGoogle Scholar
  22. 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. 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
  24. 24.
    Ros A, Gustafsson L, Krook H, Nordgren CE, Thorell A, Wallin G, Nilsson E (2001) Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a prospective, randomized, single-blind study. Ann Surg 234:741–749PubMedCrossRefGoogle Scholar
  25. 25.
    Sabharwal AJ, Minford EJ, Marson LP, Muir IM, Hill D, Auld CD (1998) Laparoscopic cholangiography: a prospective study. Br J Surg 85:624–626PubMedCrossRefGoogle Scholar
  26. 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
  27. 27.
    Trichak S (2003) Three-port vs standard four-port laparoscopic cholecystectomy. Surg Endosc 17:1434–1436PubMedCrossRefGoogle Scholar
  28. 28.
    Alkhaffaf B, Parkin E, Flook D (2011) Endoscopic retrograde cholangiopancreatography prior to laparoscopic cholecystectomy: a common and potentially hazardous technique that can be avoided. Arch Surg 146:329–333PubMedCrossRefGoogle Scholar
  29. 29.
    Amott D, Webb A, Tulloh B (2005) Prospective comparison of routine and selective operative cholangiography. ANZ J Surg 75:378–382PubMedCrossRefGoogle Scholar
  30. 30.
    Glattli A, Metzger A, Klaiber C, Seiler C, Maddern GJ, Baer HU (1994) Cholecystocholangiography vs cystic duct cholangiography during laparoscopic cholecystectomy. A prospective controlled trial. Surg Endosc 8:299–301PubMedCrossRefGoogle Scholar
  31. 31.
    Huang SM, Hsiao KM, Pan H, Yao CC, Lai TJ, Chen LY, Wu CW, Lui WY (2011) Overcoming the difficulties in laparoscopic management of contracted gallbladders with gallstones: possible role of fundus-down approach. Surg Endosc 25:284–291PubMedCrossRefGoogle Scholar
  32. 32.
    Huscher CG, Lirici MM, Di Paola M, Crafa F, Napolitano C, Mereu A, Recher A, Corradi A, Amini M (2003) Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature. Surg Endosc 17:442–451PubMedCrossRefGoogle Scholar
  33. 33.
    Hussain A, Mahmood HK, Dulku K (2008) Laparoscopic cholecystectomy can be safely performed in a resource-limited setting: the first 49 laparoscopic cholecystectomies in Yemen. JSLS 12:71–76PubMedGoogle Scholar
  34. 34.
    Kavlakoglu B, Pekcici R, Oral S (2010) Verification of clipless closure of cystic duct by harmonic scalpel. J Laparoendosc Adv Surg Tech A 20:591–595PubMedCrossRefGoogle Scholar
  35. 35.
    Kelley JE, Burrus RG, Burns RP, Graham LD, Chandler KE (1993) Safety, efficacy, cost, and morbidity of laparoscopic versus open cholecystectomy: a prospective analysis of 228 consecutive patients. Am Surg 59:23–27PubMedGoogle Scholar
  36. 36.
    Xu F, Xu CG, Xu DZ (2004) A new method of preventing bile duct injury in laparoscopic cholecystectomy. World J Gastroenterol 10:2916–2918PubMedGoogle Scholar
  37. 37.
    Yamashita Y, Kurohiji T, Kakegawa T (1994) Evaluation of two training programs for laparoscopic cholecystectomy: incidence of major complications. World J Surg 18:279–285 discussion 285PubMedCrossRefGoogle Scholar
  38. 38.
    Biffl WL, Moore EE, Offner PJ, Franciose RJ, Burch JM (2001) Routine intraoperative laparoscopic ultrasonography with selective cholangiography reduces bile duct complications during laparoscopic cholecystectomy. J Am Coll Surg 193:272–280PubMedCrossRefGoogle Scholar
  39. 39.
    Buanes T, Mjaland O, Waage A, Langeggen H, Holmboe J (1998) A population-based survey of biliary surgery in Norway. Relationship between patient volume and quality of surgical treatment. Surg Endosc 12:852–855PubMedCrossRefGoogle Scholar
  40. 40.
    Buanes T, Waage A, Mjaland O, Solheim K (1996) Bile leak after cholecystectomy significance and treatment: results from the National Norwegian Cholecystectomy Registry. Int Surg 81:276–279PubMedGoogle Scholar
  41. 41.
    Cagir B, Rangraj M, Maffuci L, Ostrander LE, Herz BL (1994) A retrospective analysis of laparoscopic and open cholecystectomies. J Laparoendosc Surg 4:89–100PubMedCrossRefGoogle Scholar
  42. 42.
    Carlson MA, Ludwig KA, Frantzides CT, Cattey RP, Henry LG, Walker AP, Schulte WJ, Wilson SD (1993) Routine or selective intraoperative cholangiography in laparoscopic cholecystectomy. J Laparoendosc Surg 3:27–33PubMedCrossRefGoogle Scholar
  43. 43.
    Chau CH, Tang CN, Siu WT, Ha JP, Li MK (2002) Laparoscopic cholecystectomy versus open cholecystectomy in elderly patients with acute cholecystitis: retrospective study. Hong Kong Med J 8:394–399PubMedGoogle Scholar
  44. 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
  45. 45.
    de Vries A, Donkervoort SC, van Geloven AA, Pierik EG (2005) Conversion rate of laparoscopic cholecystectomy after endoscopic retrograde cholangiography in the treatment of choledocholithiasis: does the time interval matter? Surg Endosc 19:996–1001PubMedCrossRefGoogle Scholar
  46. 46.
    Fletcher DR, Hobbs MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ, Knuiman MW, Sheiner HJ, Edis A (1999) Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 229:449–457PubMedCrossRefGoogle Scholar
  47. 47.
    Gelmini R, Franzoni C, Zona S, Andreotti A, Saviano M (2010) Laparoscopic cholecystectomy with Harmonic scalpel. JSLS 14:14–19PubMedCrossRefGoogle Scholar
  48. 48.
    Hanif F, Ahmed Z, Samie MA, Nassar AH (2010) Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones. Surg Endosc 24:1552–1556PubMedCrossRefGoogle Scholar
  49. 49.
    Nickkholgh A, Soltaniyekta S, Kalbasi H (2006) Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: a survey of 2,130 patients undergoing laparoscopic cholecystectomy. Surg Endosc 20:868–874PubMedCrossRefGoogle Scholar
  50. 50.
    Wu SD, Han JY, Tian Y (2011) Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a retrospective comparative study. J Laparoendosc Adv Surg Tech A 21:25–28PubMedCrossRefGoogle Scholar
  51. 51.
    Joseph M, Phillips MR, Farrell TM, Rupp CC (2012) Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate: a review and a word of caution. Ann Surg 256:1–6PubMedCrossRefGoogle Scholar
  52. 52.
    AQUA (2011) Institute for Applied Quality Improvement and Research in Health Care GmbH. German Hospital Quality Report 2010Google Scholar
  53. 53.
    Harboe KM, Bardram L (2011) The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database. Surg Endosc 25:1630–1641PubMedCrossRefGoogle Scholar
  54. 54.
    Harboe KM, Bardram L (2011) Nationwide quality improvement of cholecystectomy: results from a national database. Int J Qual Health Care 23:565–573PubMedCrossRefGoogle Scholar
  55. 55.
    Karvonen J, Salminen P, Gronroos JM (2011) Bile duct injuries during open and laparoscopic cholecystectomy in the laparoscopic era: alarming trends. Surg Endosc 25:2906–2910PubMedCrossRefGoogle Scholar
  56. 56.
    Chuang KI, Corley D, Postlethwaite DA, Merchant M, Harris HW (2012) Does increased experience with laparoscopic cholecystectomy yield more complex bile duct injuries? Am J Surg 203:480–487PubMedCrossRefGoogle Scholar
  57. 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
  58. 58.
    Giger U, Ouaissi M, Schmitz SF, Krahenbuhl S, Krahenbuhl L (2011) Bile duct injury and use of cholangiography during laparoscopic cholecystectomy. Br J Surg 98:391–396PubMedCrossRefGoogle Scholar
  59. 59.
    Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidl H (1991) The European experience with laparoscopic cholecystectomy. Am J Surg 161:385–387PubMedCrossRefGoogle Scholar
  60. 60.
    Hunter JG (1994) Laparoscopic cholecystectomy and the common bile duct. Surg Endosc 8:285–286PubMedCrossRefGoogle Scholar
  61. 61.
    Strasberg SM (2005) Biliary injury in laparoscopic surgery: part 2. Changing the culture of cholecystectomy. J Am Coll Surg 201:604–611PubMedCrossRefGoogle Scholar
  62. 62.
    Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG (2001) Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg 234:549–558 discussion 558-549PubMedCrossRefGoogle Scholar
  63. 63.
    Lekawa M, Shapiro SJ, Gordon LA, Rothbart J, Hiatt JR (1995) The laparoscopic learning curve. Surg Laparosc Endosc 5:455–458PubMedGoogle Scholar
  64. 64.
    Ford JA, Soop M, Du J, Loveday BP, Rodgers M (2012) Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg 99:160–167PubMedCrossRefGoogle Scholar
  65. 65.
    Buddingh KT, Nieuwenhuijs VB, van Buuren L, Hulscher JB, de Jong JS, van Dam GM (2011) Intraoperative assessment of biliary anatomy for prevention of bile duct injury: a review of current and future patient safety interventions. Surg Endosc 25:2449–2461PubMedCrossRefGoogle Scholar
  66. 66.
    Pfluke JM, Bowers SP (2011) Laparoscopic intraoperative biliary ultrasonography: findings during laparoscopic cholecystectomy for acute disease. J Laparoendosc Adv Surg Tech A 21:505–509PubMedCrossRefGoogle Scholar
  67. 67.
    Hashimoto M, Matsuda M, Watanabe G (2010) Intraoperative ultrasonography for reducing bile duct injury during laparoscopic cholecystectomy. Hepatogastroenterology 57:706–709PubMedGoogle Scholar
  68. 68.
    Hublet A, Dili A, Lemaire J, Mansvelt B, Molle G, Bertrand C (2009) Laparoscopic ultrasonography as a good alternative to intraoperative cholangiography (IOC) during laparoscopic cholecystectomy: results of prospective study. Acta Chir Belg 109:312–316PubMedGoogle Scholar
  69. 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
  70. 70.
    Santambrogio R, Bianchi P, Opocher E, Mantovani A, Schubert L, Ghelma F, Panzera M, Verga M, Spina GP (1996) Intraoperative ultrasonography (IOUS) during laparoscopic cholecystectomy. Surg Endosc 10:622–627PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • M. Eikermann
    • 1
  • R. Siegel
    • 2
  • I. Broeders
    • 3
  • C. Dziri
    • 4
  • A. Fingerhut
    • 5
  • C. Gutt
    • 6
  • T. Jaschinski
    • 1
  • A. Nassar
    • 7
  • A. M. Paganini
    • 8
  • D. Pieper
    • 1
  • E. Targarona
    • 9
  • M. Schrewe
    • 10
  • A. Shamiyeh
    • 11
  • M. Strik
    • 12
  • E. A. M. Neugebauer
    • 1
  1. 1.Institute for Research in Operative Medicine (IFOM), Faculty of HealthWitten/Herdecke UniversityCologneGermany
  2. 2.Department of Visceral, Vascular, and Transplantation Surgery, Faculty of HealthWitten/Herdecke UniversityCologneGermany
  3. 3.Meander Medisch Centrum, Afdeling ChirurgieAmersfoortThe Netherlands
  4. 4.Department B of General Surgery, Hôpital Charles NicolleUniversity of Tunis El ManarTunisTunisia
  5. 5.First Department of Propaedeutic SurgeryHippokration Hospital, Athens Medical School GreeceAthensGreece
  6. 6.Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Klinikum MemmingenMemmingenGermany
  7. 7.BMI Ross Hall HospitalGlasgowUK
  8. 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 RomaRomeItaly
  9. 9.Service of Surgery, Hospital de SantpauAutonomous University Autonomous of BarcelonaBarcelonaSpain
  10. 10.GRB-Consulting Company for Risk-ManagementDetmoldGermany
  11. 11.Ludwig Boltzmann Institute for Operative Laparoscopy, 2nd Surgical DepartmentAcademic Teaching Hospital, AKH LinzLinzAustria
  12. 12.Klinik für Allgemein-, Viszeral- und Onkologische ChirurgieHELIOS Klinikum Berlin-BuchBerlinGermany

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