Prevention and acute management of biliary injuries during laparoscopic cholecystectomy: Expert consensus statement.
Gallstone disease is very common and laparoscopic cholecystectomy is one of the most common surgical procedures all over the world. Parallel to the increase in the number of laparoscopic cholecystectomies, bile duct injuries also increased. The reported incidence of bile duct injuries ranges from 0.3% to 1.4%. Many of the bile duct injuries during laparoscopic cholecystectomy are not due to inexperience, but are the result of basic technical failures and misinterpretations. A working group of expert hepatopancreatobiliary surgeons, an endoscopist, and a specialist of forensic medicine study searched and analyzed the publications on safe cholecystectomy and biliary injuries complicating laparoscopic cholecystectomy under the organization of Turkish Hepatopancreatobiliary Surgery Association. After a series of e-mail communications and two conferences, the expert panel developed consensus statements for safe cholecystectomy, management of biliary injuries and medicolegal issues. The panel concluded that iatrogenic biliary injury is an overwhelming complication of laparoscopic cholecystectomy and an important issue in malpractice claims. Misidentification of the biliary system is the major cause of biliary injuries. To avoid this, the "critical view of safety" technique should be employed in all the cases. If biliary injury is identified intraoperatively, reconstruction should only be performed by experienced hepatobiliary surgeons. In the postoperative period, any deviation from the expected clinical course of recovery should alert the surgeon about the possibility of biliary injury.
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Osman
O
Abbasoğlu
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Yaman
Y
Tekant
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Aydın
A
Alper
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Ünal
Ü
Aydın
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Ahmet
A
Balık
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Birol
B
Bostancı
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Ahmet
A
Coker
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Mutlu
M
Doğanay
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Haldun
H
Gündoğdu
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Erhan
E
Hamaloğlu
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Metin
M
Kapan
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Sedat
S
Karademir
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Kaan
K
Karayalçın
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Sadık
S
Kılıçturgay
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Mustafa
M
Şare
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Ali Rıza
AR
Tümer
Turkish Association of Hepatopancreatobiliary Surgery Study Group, Ankara, Turkey.
Gökhan
G
Yağcı
Bile duct; bile duct injury; laparoscopic cholecystectomy