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Bile Duct Injury Elimination—Can We Get There?

Lillemoe, Keith D. MD; Talamini, Mark A. MD

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doi: 10.1097/SLA.0000000000003892
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The introduction of laparoscopic cholecystectomy >30 years ago initiated a dramatic new era of modern minimally invasive surgery. Unfortunately, the stubbornly persistent increased incidence of bile duct injury has accompanied the dramatic advantages of laparoscopic cholecystectomy. The short- and long-term patient morbidity, disruption of quality of life, financial costs, and medical legal ramifications of these injuries have established bile duct injury as the “Achilles Heel” of laparoscopic cholecystectomy, adversely impacting patients, surgeons, and the health care system. Bile duct injury affects between 2 and 4 patients per thousand of the nearly 1 million patients undergoing this procedure in the United States each year, as well as 1 in 3 general surgeons who perform the procedure. To address these ongoing issues, the Society of Gastrointestinal and Endoscopic Surgeons (SAGES) formed the Safe Cholecystectomy Task Force in 2014 with the ambitious goals of creating a universal culture of safety around this operation and eliminating biliary injuries. Recognizing the importance of education and the involvement of all surgeon stakeholders, this highly motivated group created a multi-society task force to organize a consensus conference to focus on the prevention of bile duct injury during cholecystectomy. The SAGES team expanded their effort to include the Americas Hepato-Pancreato-Biliary Association, the International Hepato-Pancreato-Biliary Association, the Society for Surgery the Alimentary Tract, and the European Association of Endoscopic Surgery. All of these organizations sent representatives to the consensus conference held in Boston in October 2018; expert and audience voting panels were also appointed. The fruit of this enterprise, led by SAGES past-president Michael Brunt and others, is the creation of the well-written manuscript entitled “Safe Cholecystectomy Multi-Society Practice Guidelines and State of the Art Consensus Conference on Prevention of Bile Duct Injury during Cholecystectomy” published herein. It is a great honor for Annals of Surgery and Surgical Endoscopy, the official journal of SAGES, to jointly publish this very important document.1

You will find in this manuscript answers to 18 key questions that the group deliberated during the consensus conference with appropriate recommendations. Based upon the available data, most of the recommendations lack the highest-level of evidence and therefore are considered conditional. Despite this, the gathered experts believe these recommendations represent the best and highest-quality recommendations. These guidelines are clearly a major step forward in expanding the “Culture of Safety” for laparoscopic cholecystectomy, to the great benefit of surgeons, learners, health care systems, and most importantly our patients.

We urge you not only to read this manuscript but to refer to the journal's websites to access to the supportive evidence placed in the appendices. Due to the importance of this manuscript, both journals will provide a limited period of open access to our readership to widely disseminate the message. We want to thank SAGES and the other supporting organizations, the authors, and all the members of the consensus conference for their participation and dedication to this process. We hope that this is a major step in insuring patient safety for the most common intra-abdominal surgical operation performed in the United States.


1. Brunt LM, Deziel DJ, Telem DA, et al. Safe cholecystectomy multi-society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Ann Surg. 2020;272:3–23.
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