Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul-de-sac or the birth pangs of a new technical framework?

Yukio Iwashita, Taizo Hibi, Tetsuji Ohyama, Akiko Umezawa, Tadahiro Takada, Steven M. Strasberg, Horacio J. Asbun, Henry A. Pitt, Ho Seong Han, Tsann Long Hwang, Kenji Suzuki, Yoo Seok Yoon, In Seok Choi, Dong Sup Yoon, Wayne Shih Wei Huang, Masahiro Yoshida, Go Wakabayashi, Fumihiko Miura, Kohji Okamoto, Itaru EndoEduardo de Santibañes, Mariano Eduardo Giménez, John A. Windsor, O. James Garden, Dirk J. Gouma, Daniel Cherqui, Giulio Belli, Christos Dervenis, Daniel J. Deziel, Eduard Jonas, Palepu Jagannath, Avinash Nivritti Supe, Harjit Singh, Kui Hin Liau, Xiao Ping Chen, Angus C.W. Chan, Wan Yee Lau, Sheung Tat Fan, Miin Fu Chen, Myung Hwan Kim, Goro Honda, Atsushi Sugioka, Koji Asai, Keita Wada, Yasuhisa Mori, Ryota Higuchi, Takeyuki Misawa, Manabu Watanabe, Naoki Matsumura, Toshiki Rikiyama, Naohiro Sata, Nobuyasu Kano, Hiromi Tokumura, Taizo Kimura, Seigo Kitano, Masafumi Inomata, Koichi Hirata, Yoshinobu Sumiyama, Kazuo Inui, Masakazu Yamamoto

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Bile duct injury (BDI) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons’ perceptions is scarce. Surgeons from Japan, Korea, Taiwan, and the USA, etc. (n = 614) participated in a questionnaire regarding their BDI experience and near-misses; and perceptions on landmarks, intraoperative findings, and surgical techniques. Respondents voted for a Delphi process and graded each item on a five-point scale. The consensus was built when ≥80% of overall responses were 4 or 5. Response rates for the first- and second-round Delphi were 60.6% and 74.9%, respectively. Misidentification of local anatomy accounted for 76.2% of BDI. Final consensus was reached on: (1) Effective retraction of the gallbladder, (2) Always obtaining critical view of safety, and (3) Avoiding excessive use of electrocautery/clipping as vital procedures; and (4) Calot's triangle area and (5) Critical view of safety as important landmarks. For (6) Impacted gallstone and (7) Severe fibrosis/scarring in Calot's triangle, bail-out procedures may be indicated. A consensus was reached among expert surgeons on relevant landmarks and intraoperative findings and appropriate surgical techniques to avoid BDI.

Original languageEnglish
Pages (from-to)591-602
Number of pages12
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume24
Issue number11
DOIs
Publication statusPublished - Nov 2017

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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