2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy
Рекомендации WSES 2020 года по выявлению и лечению повреждений желчных протоков во время холецистэктомии
2021-06-10
SCID: 54.1/aenzph3q
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BDI managementWSES guidelinesbile duct injurycholecystectomyreconstructive strategy
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Abstract (AI)
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.
Key Findings
1
Accurate diagnosis and precise injury description are essential for timely decision-making and successful management.
2
Bile duct injury occurs in approximately 0.4–1.5% of cholecystectomies and can cause substantial morbidity, mortality, and long-term quality-of-life impairment.
3
Most bile duct injuries are recognized intraoperatively or immediately after surgery, but delayed diagnosis can lead to inappropriate treatment and worse outcomes.
4
The 2020 WSES guidelines provide evidence-based recommendations to standardize prevention, classification, investigation, antibiotic use, and intraoperative or postoperative management of bile duct injuries.
5
The choice and timing of reconstructive treatment critically influence long-term prognosis, requiring multidisciplinary strategies with varying invasiveness.
Research Object
Bile duct injury during cholecystectomy
Research Subject
Detection, classification, prevention, and multidisciplinary management of bile duct injury, including timing and choice of reconstructive treatment
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2021-06-10
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