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

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.

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]))

Appendix 2: additional information for guideline development

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