2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy
Authors: de’Angelis Nicola , Catena Fausto , Memeo Riccardo , Coccolini Federico , Martínez-Pérez Aleix , Romeo Oreste M. , De Simone Belinda , Di Saverio Salomone , Brustia Raffaele , Rhaiem Rami , Piardi Tullio , Conticchio Maria , Marchegiani Francesco , Beghdadi Nassiba , Abu-Zidan Fikri M. , Alikhanov Ruslan , Allard Marc-Antoine , Allievi Niccolò , Amaddeo Giuliana , Ansaloni Luca , Andersson Roland , Andolfi Enrico , Azfar Mohammad , Bala Miklosh , Benkabbou Amine , Ben-Ishay Offir , Bianchi Giorgio , Biffl Walter L. , Brunetti Francesco , Carra Maria Clotilde , Casanova Daniel , Celentano Valerio , Ceresoli Marco , Chiara Osvaldo , Cimbanassi Stefania , Bini Roberto , Coimbra Raul , Luigi de’Angelis Gian , Decembrino Francesco , De Palma Andrea , de Reuver Philip R. , Domingo Carlos , Cotsoglou Christian , Ferrero Alessandro , Fraga Gustavo P. , Gaiani Federica , Gheza Federico , Gurrado Angela , Harrison Ewen , Henriquez Angel , Hofmeyr Stefan , Iadarola Roberta , Kashuk Jeffry L. , Kianmanesh Reza , Kirkpatrick Andrew W. , Kluger Yoram , Landi Filippo , Langella Serena , Lapointe Real , Le Roy Bertrand , Luciani Alain , Machado Fernando , Maggi Umberto , Maier Ronald V. , Mefire Alain Chichom , Hiramatsu Kazuhiro , Ordoñez Carlos , Patrizi Franca , Planells Manuel , Peitzman Andrew B. , Pekolj Juan , Perdigao Fabiano , Pereira Bruno M. , Pessaux Patrick , Pisano Michele , Puyana Juan Carlos , Rizoli Sandro , Portigliotti Luca , Romito Raffaele , Sakakushev Boris , Sanei Behnam , Scatton Olivier , Serradilla-Martin Mario , Schneck Anne-Sophie , Sissoko Mohammed Lamine , Sobhani Iradj , ten Broek Richard P. , Testini Mario , Valinas Roberto , Veloudis Giorgos , Vitali Giulio Cesare , Weber Dieter , Zorcolo Luigi , Giuliante Felice , Gavriilidis Paschalis , Fuks David , Sommacale Daniele 
Published: June 2021

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.