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.
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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The supportive work of Sunya-Lee Antoine, Monika Becker, Christoph Mosch, and Maren Walgenbach Institute for Research in Operative Medicine (IFOM, Witten/Herdecke University) is highly appreciated.
DisclosuresThe authors have no conflicts of interest or financial ties to disclose.
Author information Authors and AffiliationsInstitute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Straße 200, 51109, Cologne, Germany
M. Eikermann, T. Jaschinski, D. Pieper & E. A. M. Neugebauer
Department of Visceral, Vascular, and Transplantation Surgery, Faculty of Health, Witten/Herdecke University, Campus Cologne-Merheim, Cologne, Germany
R. Siegel
Meander Medisch Centrum, Afdeling Chirurgie, Amersfoort, The Netherlands
I. Broeders
Department B of General Surgery, Hôpital Charles Nicolle, University of Tunis El Manar, Boulevard du 9 avril 1938, Tunis, 1006, Tunisia
C. Dziri
First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School Greece, 115 27, Athens, Greece
A. Fingerhut
Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Klinikum Memmingen, Memmingen, Germany
C. Gutt
BMI Ross Hall Hospital, Glasgow, UK
A. Nassar
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
A. M. Paganini
Service of Surgery, Hospital de Santpau, Autonomous University Autonomous of Barcelona, Barcelona, Spain
E. Targarona
GRB-Consulting Company for Risk-Management, Klingenbergstraße 4, 32758, Detmold, Germany
M. Schrewe
Ludwig Boltzmann Institute for Operative Laparoscopy, 2nd Surgical Department, Academic Teaching Hospital, AKH Linz, Linz, Austria
A. Shamiyeh
Klinik für Allgemein-, Viszeral- und Onkologische Chirurgie, HELIOS Klinikum Berlin-Buch, Berlin, Germany
M. Strik
Correspondence to E. A. M. Neugebauer.
Appendices Appendix 1: search strategy Search strategy Medline via Pubmed(((((Laparoscop* OR Celioscop* OR Coelioscop* OR Abdominoscop* OR Peritoneoscop* OR lap) AND (cholecystectom* OR colecystecto* OR chole) OR “Cholecystectomy, Laparoscopic” [Mesh]) AND ((((injur* OR bile leak* OR biliary leak* OR transection* OR occlusion* OR stricture* OR stenosis* OR obstruct* OR laceration* OR damage*) OR (harm* OR convers* OR “Peritonitis”[MeSH] OR peritonitis OR “Cholestasis”[Mesh] OR Cholestas*) OR (peritone* AND inflamma*) OR ((biliary OR bile) AND stas*)) AND (bile duct* OR biliary tract*)) OR “Biliary Tract/injuries”[Mesh])) AND (German [LA] OR English [LA]))) NOT (animals [MeSH] NOT (humans [MeSH] AND animals [MeSH]))
Search strategy Cochrane Central Register of Controlled Trials (Central; Clinical Trials) via Cochrane Library((((Laparoscop* OR Celioscop* OR Coelioscop* OR Abdominoscop* OR Peritoneoscop* OR lap) AND (cholecystectom* OR colecystecto* OR chole)) OR “Cholecystectomy, Laparoscopic”[Mesh])) AND ((injur* OR bile leak* OR biliary leak* OR transection* OR occlusion* OR stricture* OR stenosis* OR obstruct* OR laceration* OR damage* OR harm* OR convers* OR “Peritonitis”[MesH] OR peritonitis OR “Cholestasis”[Mesh] OR Cholestas* OR (peritone* AND inflamma*) OR ((biliary OR bile) AND stas*)) AND ((bile duct* OR biliary tract*) OR “Biliary Tract”[Mesh]))
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Received: 22 July 2012
Accepted: 29 July 2012
Published: 06 October 2012
Issue Date: November 2012
DOI: https://doi.org/10.1007/s00464-012-2511-1
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