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Practice Guideline
. 2021 Jun 10;16(1):30.
doi: 10.1186/s13017-021-00369-w.

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

Nicola de'Angelis  1   2 , Fausto Catena  3 , Riccardo Memeo  4 , Federico Coccolini  5 , Aleix Martínez-Pérez  6 , Oreste M Romeo  7 , Belinda De Simone  8 , Salomone Di Saverio  9 , Raffaele Brustia  10 , Rami Rhaiem  11 , Tullio Piardi  11   12 , Maria Conticchio  4 , Francesco Marchegiani  13 , Nassiba Beghdadi  10 , Fikri M Abu-Zidan  14 , Ruslan Alikhanov  15 , Marc-Antoine Allard  16 , Niccolò Allievi  17 , Giuliana Amaddeo  18 , Luca Ansaloni  19 , Roland Andersson  20 , Enrico Andolfi  21 , Mohammad Azfar  22 , Miklosh Bala  23 , Amine Benkabbou  24 , Offir Ben-Ishay  25 , Giorgio Bianchi  26 , Walter L Biffl  27 , Francesco Brunetti  10 , Maria Clotilde Carra  28 , Daniel Casanova  29 , Valerio Celentano  30 , Marco Ceresoli  31 , Osvaldo Chiara  32 , Stefania Cimbanassi  32 , Roberto Bini  32 , Raul Coimbra  33 , Gian Luigi de'Angelis  34 , Francesco Decembrino  35 , Andrea De Palma  5 , Philip R de Reuver  36 , Carlos Domingo  6 , Christian Cotsoglou  37 , Alessandro Ferrero  38 , Gustavo P Fraga  39 , Federica Gaiani  34 , Federico Gheza  40 , Angela Gurrado  41 , Ewen Harrison  42 , Angel Henriquez  43 , Stefan Hofmeyr  44 , Roberta Iadarola  3 , Jeffry L Kashuk  45 , Reza Kianmanesh  11 , Andrew W Kirkpatrick  46 , Yoram Kluger  25 , Filippo Landi  47 , Serena Langella  38 , Real Lapointe  48 , Bertrand Le Roy  49 , Alain Luciani  50 , Fernando Machado  51 , Umberto Maggi  52 , Ronald V Maier  53 , Alain Chichom Mefire  54 , Kazuhiro Hiramatsu  55 , Carlos Ordoñez  56 , Franca Patrizi  57 , Manuel Planells  6 , Andrew B Peitzman  58 , Juan Pekolj  59 , Fabiano Perdigao  60 , Bruno M Pereira  39 , Patrick Pessaux  61 , Michele Pisano  17 , Juan Carlos Puyana  62 , Sandro Rizoli  63 , Luca Portigliotti  64 , Raffaele Romito  64 , Boris Sakakushev  65 , Behnam Sanei  66 , Olivier Scatton  60 , Mario Serradilla-Martin  67 , Anne-Sophie Schneck  68 , Mohammed Lamine Sissoko  69 , Iradj Sobhani  70 , Richard P Ten Broek  36 , Mario Testini  41 , Roberto Valinas  71 , Giorgos Veloudis  72 , Giulio Cesare Vitali  73 , Dieter Weber  74 , Luigi Zorcolo  75 , Felice Giuliante  76 , Paschalis Gavriilidis  77 , David Fuks  78 , Daniele Sommacale  10
Affiliations
Practice Guideline

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

Nicola de'Angelis et al. World J Emerg Surg. .

Abstract

Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.

Keywords: Antibiotic therapy; Biliary duct injury; Computed tomography; Guidelines; Laparoscopic cholecystectomy; Magnetic resonance imaging.

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Conflict of interest statement

All authors declare that they have no competing interests in relation to the matter of this publication.

Figures

Fig. 1
Fig. 1
Decisional tree in case of intra-operatively detected BDI. N stands for no, Y for yes
Fig. 2
Fig. 2
Decisional tree in case of post-operatively detected BDI. N stands for no
See this image and copyright information in PMC

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