Safe Cholecystectomy Multi-society Practice Guideline and... : Annals of Surgery (original) (raw)

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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

Brunt, L. Michael MD∗; Deziel, Daniel J. MD†; Telem, Dana A. MD, MPH‡; Strasberg, Steven M. MD∗; Aggarwal, Rajesh MD§; Asbun, Horacio MD¶; Bonjer, Jaap MD||; McDonald, Marian MD∗∗; Alseidi, Adnan MD††; Ujiki, Mike MD‡‡; Riall, Taylor S. MD, PhD§§; Hammill, Chet MD∗; Moulton, Carol-Anne MD¶¶; Pucher, Philip H. MD||||; Parks, Rowan W. MD∗∗∗; Ansari, Mohammed T. MD, MMedSc, MPhil†††; Connor, Saxon MD‡‡‡; Dirks, Rebecca C. MD§§§; Anderson, Blaire MD∗; Altieri, Maria S. MD∗; Tsamalaidze, Levan MD¶¶¶; Stefanidis, Dimitrios MD, PhD§§§

∗Washington University School of Medicine, St. Louis, MO

†Rush University Medical Center, Chicago IL

‡University of Michigan School of Medicine, Ann Arbor, MI

§Thomas Jefferson University School of Medicine, Philadelphia, PA

¶Miami Baptist Cancer Center, Miami, FL

||VUmc University Medical Centre, Amsterdam, NE

∗∗St. Luke's University and Health Network, Allentown, PA

††Virginia Mason Medical Center, Seattle, WA

‡‡NorthShore University Health System, Chicago, IL

§§University of Arizona School of Medicine, Tucson, AZ

¶¶University of Toronto, Toronto, CA

||||Imperial College London, London, England

∗∗∗University of Edinburgh, Edinburgh, Scotland, UK

†††University of Ottawa, Ottawa, CA

‡‡‡University of New Zealand, Christ Church, NZ

§§§Indiana University School of Medicine, Indianapolis, IN

¶¶¶Tbilisi State Medical University, Tbilisi, Georgia

||||||See credits at end of manuscript.

[email protected].

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.

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.

L. Michael Brunt, MD – guideline/consensus chair, concept design and data acquisition/analysis, drafting and revision manuscript; Daniel J. Deziel, MD – group lead, concept design and data analysis, drafting, and revision manuscript; Dana A. Telem, MD, MPH – group lead, concept design and data analysis, drafting and revision manuscript; Steven M. Strasberg, MD – group lead, concept design and data acquisition/analysis, drafting and revision manuscript; Rajesh Aggarwal, MD – group lead, concept design and data analysis, drafting and revision manuscript; Horacio Asbun, MD – group lead, concept design and data analysis, drafting and revision manuscript; Jaap Bonjer, MD – group co-lead, data analysis, manuscript revision; Marian McDonald, MD – group co-lead, data acquisition and analysis, manuscript revision; Adnan Alseidi, MD – group co-lead, data acquisition and analysis, drafting and revision manuscript; Mike Ujiki, MD – group co-lead, data acquisition and analysis, drafting and revision manuscript; Taylor S. Riall, MD, PhD – group co-lead, data acquisition and analysis, drafting and revision manuscript; Chet Hammill, MD – group co-lead, data acquisition and analysis, manuscript revision; Carol-Anne Moulton, MD – group co-lead, data acquisition and analysis; Philip H. Pucher, MD – group co-lead, data acquisition and analysis, manuscript revision; Rowan W. Parks, MD – group co-lead, data acquisition and analysis, manuscript revision; Mohammed T. Ansari, MD, MMedSc, MPhil – concept design, data analysis, drafting and revision manuscript; Saxon Connor, MD – group co-lead, data analysis, manuscript revision; Rebecca C. Dirks, MD – data acquisition and analysis, manuscript revision; Blaire Anderson, MD – data acquisition and analysis, manuscript revision; Maria S. Altieri, MD – data acquisition and analysis, manuscript revision; Levan Tsamalaidze, MD – data acquisition and analysis, manuscript revision; Dimitrios Stefanidis, MD, PhD – concept design, data acquisition/analysis, drafting and revision manuscript.

The authors report no conflicts of interest.

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Abstract

Background:

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 6 broad topics around cholecystectomy directed by a steering group and subject experts from 5 surgical societies (Society of Gastrointestinal and Endoscopic Surgeons, Americas Hepato-Pancreato-Biliary Association, International Hepato-Pancreato-Biliary Association, Society for Surgery of the Alimentary Tract, and European Association for Endoscopic Surgery). Evidence-based recommendations were formulated using the grading of recommendations assessment, development, and evaluation 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 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.

Conclusions:

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.