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Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy

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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.

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Acknowledgements

The Guideline Steering Group L. Michael Brunt, Daniel Deziel, Steven Strasberg, Dana Telem, Dimitrios Stefanidis. Sponsoring Society Leadership Horacio Asbun and L. Michael Brunt [SAGES], Rebecca Minter and Charles Vollmer [AHPBA], Gazi Zibari and Oscar Imventarza [IHPBA], Nat Soper [SSAT], and Jaap Bonjer [EAES]. Guideline Development Group Members:L. Michael Brunt, Dimitrios Stefanidis, Daniel Deziel, Dana Telem, Steven Strasberg, Raj Aggarwal, Horacio Asbun, Marian McDonald, Adnan Alseidi, Mike Ujiki, Taylor Riall, Chet Hammill. Saxon Connor, Carol-Anne Moulton, Phil Pucher, Rowan Parks, and Jaap Bonjer. GRADE and Evidence Review Methodology Team Mohamed Ansari, Dimitrios Stefanidis, Valerie Rofeberg, Rebecca Dirks. SAGES Support Staff Brenda Castaneda -support for all activities of the consensus process and meeting planning, Shauna Bostian, SAGES librarian, Shelley Ginsburg, Development. *Prevention of Bile Duct Injury Consensus Group 1Domenech Asbun, MD; 2Chantel den Baaker, MD; 3Luigi Boni, MD; 4Ryan Campagna, MD; 5Eugene Ceppa, MD; 6Marie Crandall, MD; 7Chris Davis, MD; 8Shanley Deal, MD; 5Scott Dojels, MD; 9Ismael Domiguez-Rosado, MD; 2Leonie van Gastel, MD; 10Justin Gerard, MD; 11Daniel Hashimoto, MD; 12Ewen Harrison, MD; 13Sara Holden MD; 14Romeo Ignacio, MD; 15Oscar Imventarza, MD; 16Rohan Jeyarajah, MD; 10MacKenzie Landin; 17Charles Lawrence, MD; 18Marc Mesleh, MD; 5Sara Monafred, MD; 19Alessandro Paganini, MD; 20B. Fernando Santos; 21Sadiq Sikora, MD; 5Tim Schaffner, MD; 22Nate Stoikes, MD; 23Bailey Su, MD; 24Megan Thomas; 10Ben Veenstra, MD; 25Waala Abdelmoaty, MD; and 2Eline Zwart, MD. 1University of California San Francisco-Fresno, Fresno, CA; 2VUmc University Medical Centre, Amsterdam, NE; 3Policlinico Hospital, University of Milan, Milan, Italy; 4Northwestern University school of Medicine, Chicago, IL; 5Indiana University School of Medicine, Indianapolis, IN; 6University of Florida College of Medicine, Jacksonville, FL; 7Medical College of Wisconsin, Milwaukee, WI; 8Virginia Mason Medical Center, Seattle, WA; 9National Institute of Medical Science and Nutrition, Mexico City, Mexico; 10Rush University Medical Center, Chicago, IL; 11Massachusetts General Hospital/Harvard Medical School, Boston, MA; 12University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, Scotland, 13Washington University School of Medicine, St. Louis, MO; 14University Naval Medical Center, San Diego, CA; 15Hospital Dr Juan P Garrahan, Buenos Aires, Argentina; 16Methodist Dallas Medical Center, Dallas, TX; 17University of Arizona, Tucson, AZ; 18Advocate Medical Group, Oak Lawn, IL; 19Sapienza University of Rome, Italy; 20Dartmouth University School of Medicine, Concord, NH 21Sakra World Hospital Bangalore, India; 22University of Tennessee Health sciences Center, Memphis, TN; 23NorthShore University Health System, Chicago, IL; 24Christchurch Hospital, Canterbury District Health Board, NZ; 25Providence Medical Center, Portland OR.

Funding

The consensus meeting was supported by Grants from the SAGES Education and Research Foundation and an R-13 conference Grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIDDK Award Number R13DK120271-01). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We also acknowledge consensus day meeting support by unrestricted education grants from Intuitive Surgical, Medtronic. Karl Storz Endoscopy, Stryker Endoscopy, Boston Scientific, and Ethicon, Inc.

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Dr. Raj Aggarwal has been a consultant for Applied Medical; Dr. Adnan Alseidi is a consultant for Johnson & Johnson; Dr. Horacio Asbun has received honoraria from Medtronic for speaking/teaching; Dr. Jaap Bonjer has research grant support from Applied Medical, Johnson & Johnson, and Medtronic, institutional educational grant support from Stryker Endoscopy, and honoraria from Olympus for speaking/teaching; Dr. Michael Brunt has institutional research support from Gore Medical and Karl Storz Endoscopy and honoraria for speaking/teaching from Intuitive Surgical; Dr. Chet Hammill has been a consultant for Medtronic, Intuitive Surgical, and Novadaq; Dr. Philip Pucher is a consultant for Fundamental Surgery; Dr. Dana Telem has received honoraria for speaking/teaching from Gore Medical and Medtronic; Dr. Mike Ujiki is a consultant for Applied Endosurgical, Boston Scientific, and Olympus and has received honoraria for speaking/teaching from Gore Medical and Medtronic. Drs. Daniel Deziel, Steven Strasberg, Marian McDonald, Taylor Riall, Carol-Anne Moulton, Rowan Parks, Mohammed Ansari, Saxon Connor, Rebecca Dirks, Blaire Anderson, Maria Altieri, Levan Tsamalaidze, and Dimitrios Stefanidis have no conflicts of interest or financial ties to disclose.

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Brunt, L.M., Deziel, D.J., Telem, D.A. et al. Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy. Surg Endosc 34, 2827–2855 (2020). https://doi.org/10.1007/s00464-020-07568-7

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