EC Gastroenterology and Digestive System

Introduction: The laparoscopic cholecystectomy is the gold standard of treatment of gallstones. However, it also has raised of certain complications compared to open cholecystectomy. Bile duct injury is the most catastrophic complication after cholecystectomy. For that reason, improving the safety of cholecystectomy is a constant and important task.

Methods: A literature search in English has been performed in the MEDLINE, Embase, and Science Citation Index. A mini-review of the most relevant recommendations in safe cholecystectomy was carried out.

Results: One of the factors that predispose to bile duct injury is poor visibility of the structures in Calot's triangle. The critical view of safety has proven to be a helpful tool in improving the safety of the cholecystectomy. If the safety of cholecystectomy cannot be achieved through the critical view of safety, it is advisable to re-evaluate anatomical landmarks, re-explore Calot's triangle, and consider performing bail-out procedures.

Conclusion: Safety manoeuvres in laparoscopic cholecystectomy should be performed routinely. Ensuring good vision with critical safety vision is an important component in laparoscopic cholecystectomy. In case of not obtaining it, the bail-out procedures are a recommended option.

Keywords: Laparoscopic Cholecystectomy; Bile Duct Injuries; Complications; Safe Cholecystectomy; Review

1. Schirmer BD., et al. “Cholelithiasis and cholecystitis”. Journal of Long-Term Effects of Medical Implants 3 (2005): 329-338.
2. Chuang SC., et al. “Genetics of gallstone disease”. Advances in Clinical Chemistry 60 (2013): 143-185.
3. Macintyre IM and Wilson RG. “Laparoscopic cholecystectomy”. British Journal of Surgery 5 (1993): 552-559.
4. Hariharan D., et al. “Quality of Life and Medico-Legal Implications Following Iatrogenic Bile Duct Injuries”. World Journal of Surgery 1 (2017): 90-99.
5. Cohen JT., et al. “An Update on Iatrogenic Biliary Injuries: Identification, Classification, and Management”. Surgical Clinics of North America 2 (2019): 283-299.
6. Díaz-Martínez J., et al. “Bile duct injuries after cholecystectomy, analysis of constant risk”. Annals of Hepato-Biliary-Pancreatic Surgery 2 (2020): 150-155.
7. Booij KA., et al. “Insufficient safety measures reported in operation notes of complicated laparoscopic cholecystectomies”. Surgery 3 (2014): 384-389.
8. Díaz-Martínez J., et al. “Iatrogenic Duodenal Injuries, Analysis of the Surgical Treatment”. Surgery, Gastroenterology and Oncology (2021): eC-325.
9. Kapoor VK. “Non-biliary Injuries During cholecystectomy”. Post-Cholecystectomy Bile Duct Injury, Springer (2020).
10. Machado NO. “Duodenal injury post laparoscopic cholecystectomy: Incidence, mechanism, management and outcome”. World Journal of Gastrointestinal Surgery 4 (2016): 335-344.
11. Conrad C., et al. “IRCAD recommendation on safe laparoscopic cholecystectomy”. Journal of Hepato-Biliary-Pancreatic Sciences 24 (2017): 603-615.
12. Brunt LM., et al. “Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy”. Annals of Surgery 1 (2020): 3-23.
13. Eikermann M., et al. “Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)”. Surgical Endoscopy 26 (2012): 3003-3039.
14. Wakabayashi G., et al. “Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)”. Journal of Hepato-Biliary-Pancreatic Sciences 25 (2018): 73-86.
15. Strasberg SM. “Avoidance of biliary injury during laparoscopic cholecystectomy”. Journal of Hepato-Biliary-Pancreatic Sciences 9 (2002): 543-547.
16. Bansal VK., et al. “SELSI Consensus Statement for Safe Cholecystectomy-Prevention and Management of Bile Duct Injury-Part A”. The Indian Journal of Surgery 3 (2021): 592-610.
17. Strasberg SM., et al. “An analysis of the problem of biliary injury during laparoscopic cholecystectomy”. Journal of the American College of Surgeons 1 (1995): 101-125.
18. Strasberg SM. “A three-step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy: an invited perspective review”. Journal of Hepato-Biliary-Pancreatic Sciences 26 (2019): 123-127.
19. Strasberg SM and Brunt LM. “Rationale and use of the critical view of safety in laparoscopic cholecystectomy”. Journal of the American College of Surgeons 211 (2010): 132-138.
20. Strasberg SM. “A perspective on the critical view of safety in laparoscopic cholecystectomy”. Annals of Laparoscopic and Endoscopic Surgery 2 (2017): 91.
21. LeCompte MT., et al. “Less is more in the difficult gallbladder: recent evolution of subtotal cholecystectomy in a single HPB unit”. Surgical Endoscopy 7 (2021): 3249-3257.