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SELSI Consensus Statement for Safe Cholecystectomy—Prevention and Management of Bile Duct Injury—Part B

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Abstract

Cholecystectomy is one of the commonest general surgical procedures performed all over India. The risk of bile duct injury (BDI) during laparoscopic cholecystectomy is two to three times higher than during open cholecystectomy. The worldwide incidence of bile duct injury is 0.5% or 1 in 200 cases. BDI and its consequences result in significant morbidity and may even cause mortality. BDI increases the cost of treatment and is a common reason for a medicolegal suit against the surgeons. To minimize the incidence of BDI and to manage it timely and appropriately, a set of guidelines was deemed necessary by a group of senior surgeons during a Society of Endoscopic and Laparoscopic Surgeons of India (SELSI) meeting in 2016. Guidelines for “Safe Laparoscopic Cholecystectomy” and bile duct injury management formulated by other international societies are already available. The applicability of these guidelines to Indian subjects especially in small peripheral centers was limited. Hence, a decision was taken to form a set of guidelines for general surgeons with basic laparoscopic skills with little or no advanced laparoscopic skills. Those working in a solo practice, nursing homes, and small private hospitals at talukas or districts should have “Safe Cholecystectomy” guidelines and management of BDI suitable to their situation. These guidelines were formed after three consensus meetings and have been approved by a SELSI Expert Group.

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Abbreviations

AIDS :

Acquired immune deficiency syndrome

ALP :

Alkaline phosphatase

ASA :

American Society of Anesthesiologists

BDI :

Bile duct injury

BMI :

Body mass index

CBD :

Common bile duct

CECT :

Contrast enhanced computerized tomography

CHA :

Chronic hemolytic anemia

CHD :

Common hepatic duct

COPD :

Chronic obstructive pulmonary disease

CVS :

Critical view of safety

DLC :

Delayed laparoscopic cholecystectomy

EAES :

European Association of Endoscopic Surgeons

EBF :

External biliary fistula

ELC :

Early laparoscopic cholecystectomy

ERCP :

Endoscopic retrograde cholangio-pancreatography

ESE :

Endoscopic papillotomy and stone extraction

FNAC :

Fine needle aspiration cytology

GB :

Gallbladder

HIDA :

Hepatobiliary iminodiacetic acid scan

HIV :

Human immune deficiency virus

IHBRD :

Intrahepatic biliary radical dilatation

IOC :

Intraoperative cholangiogram

IRCAD :

L’Institut de Recherchecontre les Cancers de l'AppareilDigestif

KFT :

Kidney function test

LC :

Laparoscopic cholecystectomy

LCBDE :

Laparoscopic common bile duct exploration

LFT :

Liver function test

LMWH :

Low molecular weight heparin

LOE :

Level of evidence

MRC :

Magnetic resonance cholangiogram

MRCP :

Magnetic resonance cholangio-pancreatography

MS :

Mirizzi's syndrome

OC :

Open cholecystectomy

OHA :

Oral hypoglycemic agents

SAGES :

Society of American Gastrointestinal and Endoscopic Surgeons

SELSI :

Society of Endoscopic and Laparoscopic Surgeons of India

SCD :

Sickle cell disease

TLC :

Total leucocyte count

WBC :

White blood cell

USG :

Ultrasonography

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Author information

Authors and Affiliations

  1. Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India

    Virinder Kumar Bansal, Mahesh C. Misra, Sandeep Aggarwal, Asuri Krishna, Aditya Baksi, Hemanga K Bhattacharjee, IK Dhawan, BML Kapur, Kamal Kataria, Subodh Kumar, Rajinder Parshad, Om Prakash Prajapati, Piyush Ranjan, Yashwant Singh Rathore, Vuthaluru Seenu & Anurag Srivastava

  2. Department of Surgical Gastroenterology, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India

    Anil K Agarwal

  3. Agrawal Institute of Laparoscopic Surgery, Mumbai, India

    JB Agrawal

  4. Department of Surgery, Maulana Azad Medical College, New Delhi, India

    PN Agarwal, Jagdish Chander, Pawanindra Lal & Rajdeep Singh

  5. Department of Surgery, Aligarh Muslim University, Aligarh, India

    Mohammad Aslam

  6. Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

    Anu Behari & VK Kapoor

  7. Santokba Durlabhji Memorial Hospital, Jaipur, India

    Rajesh Bhojwani

  8. Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India

    TK Chattopadhyay, NR Dash, Sujoy Pal, Rajesh Panwar & Peush Sahni

  9. Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

    Chintamani

  10. Max Superspeciality Hospital, Saket, New Delhi, India

    Pradeep Chowbey

  11. Department of Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India

    Abhay Dalvi

  12. Department of Radiology, All India Institute of Medical Sciences, New Delhi, India

    Shivanand Gamangatti & Atin Kumar

  13. Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India

    PK Garg

  14. Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    NM Gupta, Rajesh Gupta, Vikas Gupta, L Kaman, GR Verma & JD Wig

  15. Lucknow, India

    SK Gupta & Sandeep Kumar

  16. Department of Surgery, Government Medical College, Srinagar, India

    Muneer Khan

  17. Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

    Ajay K Khanna, Anand Kumar & VK Shukla

  18. Max Superspeciality Hospital, Saket, New Delhi, India

    Rajesh Khullar

  19. Sachkhand Hospital, Agra, India

    SD Maurya & Amit Srivastava

  20. Department of Surgery, Regional Institute of Medical Sciences, Imphal, India

    GS Moirangthem

  21. Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

    Biju Pottakkat

  22. Galaxy Care Laparoscopy Institute, Pune, India

    Shailesh Puntambekar

  23. Sir Ganga Ram Hospital, New Delhi, India

    Rathindra Sarangi

  24. Department of Surgery, Government Medical College, Chandigarh, India

    Rajeev Sharma

  25. Department of Surgery, Government Medical College, Patiala, India

    DP Singh

  26. Department of Surgery, Dayanand Medical College Hospital, Ludhiana, India

    Jaspal Singh

  27. Department of Surgery, Maharani Laxmibai Medical College, Jhansi, India

    Rajeev Sinha

  28. Sakra World Hospital, Bangalore, India

    Sadiq S Sikora

  29. Department of Surgery, Dr. Ram Manohar Lohia Hospital, New Delhi, India

    KN Srivastava

  30. Department of Surgery, Lady Hardinge Medical College, New Delhi, India

    Shaji Thomas

Authors
  1. Virinder Kumar Bansal
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  2. Mahesh C. Misra
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  3. Anil K Agarwal
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  4. JB Agrawal
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  5. PN Agarwal
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  6. Sandeep Aggarwal
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  7. Mohammad Aslam
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  8. Asuri Krishna
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  9. Aditya Baksi
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  10. Anu Behari
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  11. Hemanga K Bhattacharjee
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  12. Rajesh Bhojwani
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  13. Jagdish Chander
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  14. TK Chattopadhyay
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  15. Chintamani
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  16. Pradeep Chowbey
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  17. Abhay Dalvi
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  18. NR Dash
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  19. IK Dhawan
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  20. Shivanand Gamangatti
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  21. PK Garg
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  22. NM Gupta
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  23. Rajesh Gupta
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  24. SK Gupta
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  25. Vikas Gupta
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  26. L Kaman
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  27. BML Kapur
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  28. Kamal Kataria
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  29. Muneer Khan
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  30. Ajay K Khanna
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  31. Rajesh Khullar
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  32. Anand Kumar
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  33. Atin Kumar
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  34. Sandeep Kumar
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  35. Subodh Kumar
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  36. Pawanindra Lal
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  37. SD Maurya
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  38. GS Moirangthem
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  39. Sujoy Pal
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  40. Rajesh Panwar
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  41. Rajinder Parshad
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  42. Biju Pottakkat
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  43. Om Prakash Prajapati
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  44. Shailesh Puntambekar
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  45. Piyush Ranjan
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  46. Yashwant Singh Rathore
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  47. Peush Sahni
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  48. Rathindra Sarangi
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  49. Vuthaluru Seenu
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  50. Rajeev Sharma
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  51. VK Shukla
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  52. DP Singh
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  53. Jaspal Singh
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  54. Rajdeep Singh
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  55. Rajeev Sinha
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  56. Sadiq S Sikora
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  57. Amit Srivastava
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  58. Anurag Srivastava
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  59. KN Srivastava
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  60. Shaji Thomas
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  61. GR Verma
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  62. JD Wig
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  63. VK Kapoor
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Corresponding author

Correspondence to Virinder Kumar Bansal.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Disclaimer

This consensus statement is for general guidance only; the recommendations made in this statement do not cover all situations and scenarios and may be modified depending upon the infrastructure and the expertise available in a given situation.

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The term common bile duct (CBD) has been used in these guidelines. At most places, it means and includes common hepatic duct (CHD) also.

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Bansal, V.K., Misra, M., Agarwal, A.K. et al. SELSI Consensus Statement for Safe Cholecystectomy—Prevention and Management of Bile Duct Injury—Part B. Indian J Surg 83 (Suppl 3), 611–624 (2021). https://doi.org/10.1007/s12262-019-01994-1

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