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SAGES guidelines for the clinical application of laparoscopic biliary tract surgery

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Disclosures

Author Robert D. Fanelli is a board member of New Wave Surgical Corporation, received honoraria from Ethicon Endo-Surgery for speaking/teaching, received honoraria from Boston Scientific Corporation, Inc. for speaking/teaching, and was an independent contractor for Cook Surgical, Inc. Authors Keith N. Apelgren, Keenan Berghoff, Paul Curcillo, David W. Overby, and William S. Richardson have no conflicts of interest or financial ties to disclosure.

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Correspondence to Robert Fanelli.

Appendices

Appendix 1: Levels of evidence

Table 28

Appendix 2: Scale used for recommendation grading

Table 29

Appendix 3: Literature review method, search terms, and results

Literature review method

Systematic literature searches for each topic were performed on MEDLINE during the course of the review. In general, the search strategy was limited to articles in English language, on humans, and published within the last 5 years. The abstracts were reviewed by the two committee members (D.W.O., K.N.A.). Randomized controlled trials, meta-analyses, and systematic reviews were selected for further review along with prospective and retrospective studies including studies with smaller samples, which were considered when additional evidence was lacking.

Search terms and results

  1. A.

    Indications:

    1. 1.

      Search date: September 2009

    2. 2.

      Search terms: “cholecystectomy indications”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 91 articles, abstracts reviewed, 6 chosen as pertinent, 1 additional earlier landmark publication included

  2. B.

    Antibiotic prophylaxis:

    1. 1.

      Search date: July 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy prophylaxis antibiotics”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 13 articles, abstracts reviewed, 4 chosen as pertinent

  3. C.

    Abdominal access. See “Access injuries” below

  4. D.

    Safe technique:

    1. 1.

      Search date: August 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy bile duct injury prevention”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 33 articles, abstracts reviewed, 8 chosen as pertinent

  5. E.

    Intraoperative cholangiography:

    1. 1.

      Search date: August 2009

    2. 2.

      Search terms: “intraoperative cholangiogram choledocholithiasis”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 69 articles, abstracts reviewed, 12 chosen as pertinent

  6. F.

    Intraoperative ultrasound:

    1. 1.

      Search date: August 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy intraoperative ultrasound”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 59 articles, abstracts reviewed, 4 chosen as pertinent

  7. G.

    Laparoscopic bile duct exploration, ERCP with stone extraction, and altered anatomy:

    1. 1.

      Search date: August 2009

    2. 2.

      Search terms: “laparoscopic bile duct exploration”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 101 articles, abstracts reviewed, 15 chosen as pertinent

  8. H.

    Laparoscopic endobiliary stent placement:

    1. 1.

      Search date: August 2009

    2. 2.

      Search terms: “laparoscopic endobiliary stent”

    3. 3.

      Limits: None

    4. 4.

      Results: 14 articles, abstracts reviewed, 4 chosen as pertinent

  9. I.

    Dissection of the gallbladder from the liver bed:

    1. 1.

      Search date: August 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy dissection”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 83 articles, abstracts reviewed, 5 chosen as pertinent

  10. J.

    Use of drains:

    1. 1.

      Search date: August 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy drains”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 9 articles, abstracts reviewed, 2 chosen as pertinent

  11. K.

    Conversion to laparotomy:

    1. 1.

      Search date: February 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy conversion to laparotomy”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 33 articles, abstracts reviewed, 7 chosen as pertinent

  12. L.

    Access injuries:

    1. 1.

      Search date: August 2009

    2. 2.

      Search terms: “laparoscopic access complication”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 90 articles, abstracts reviewed, 4 chosen as pertinent

  13. M.

    Common bile duct injuries:

    1. 1.

      Search date: February 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy bile duct injury”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Additional hand searching of bibliographies

    5. 5.

      Results: 194 articles, abstracts reviewed, 19 chosen as pertinent

  14. N.

    Biliary dyskinesia:

    1. 1.

      Search date: September 2009

    2. 2.

      Search terms: “cholecystectomy biliary dyskinesia”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Additional hand searching of bibliographies

    5. 5.

      Results: 40 articles, abstracts reviewed, 6 chosen as pertinent

  15. O.

    Acute cholecystitis:

    1. 1.

      Search date: March 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy acute cholecystitis”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 219 articles, abstracts reviewed, 38 chosen as pertinent

  16. P.

    Gallstone pancreatitis:

    1. 1.

      Search date: April 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy acute pancreatitis”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 77 articles, abstracts reviewed, 13 chosen as pertinent

  17. Q.

    Laparoscopic cholecystectomy surgery in the setting of cirrhosis:

    1. 1.

      Search date: April 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy cirrhosis”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Additional hand searching of bibliographies

    5. 5.

      Results: 69 articles, abstracts reviewed, 13 chosen as pertinent

  18. R.

    Laparoscopic cholecystectomy surgery in the setting of systemic anticoagulation:

    1. 1.

      Search date: April 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy anticoagulation”

    3. 3.

      Limits: None

    4. 4.

      Additional hand searching of bibliographies

    5. 5.

      Results: 11 articles, abstracts reviewed, 2 chosen as pertinent

  19. S.

    Porcelain gallbladder:

    1. 1.

      Search date: April 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy porcelain gallbladder”

    3. 3.

      Limits: None

    4. 4.

      Additional hand searching of bibliographies

    5. 5.

      Results: 16 articles, abstracts reviewed, 2 chosen as pertinent

  20. T.

    Gallbladder polyps:

    1. 1.

      Search date: April 2009

    2. 2.

      Search terms: “gallbladder polyps”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 59 articles, abstracts reviewed, 6 chosen as pertinent

  21. U.

    Gallbladder cancer:

    1. 1.

      Search date: June 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy gallbladder cancer”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 108 articles, abstracts reviewed, 9 chosen as pertinent

  22. V.

    Length of stay:

    1. 1.

      Search date: July 2009

    2. 2.

      Search terms: “laparoscopic cholecystectomy hospital discharge”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 58 articles, abstracts reviewed, 8 chosen as pertinent

  23. W.

    Single-incision cholecystectomy:

    1. 1.

      Search date: September 2009

    2. 2.

      Search terms: “single incision laparoscopic cholecystectomy”

    3. 3.

      Limits: English language, humans, and published within the last 5 years

    4. 4.

      Results: 15 articles, abstracts reviewed, 3 chosen as representative

Appendix 4

This document was prepared and revised by the SAGES Guidelines Committee:

D. Wayne Overby, MD

Keith N. Apelgren, MD

Keenan R. Beghoff, MD

Paul Curcillo, MD

Ziad Awad, MD

Ronald Clements, MD

David Edelman, MD

Erika Fellinger, MD

Stephen Haggerty, MD

Steven Heneghan, MD

Henry Lujan, MD

Sumeet Mittal, MD

Jonathan Pearl, MD

Raymond Price, MD

Patrick Reardon, MD

John Roth, MD

Alan Saber, MD

Dimitrios Stefanidis, MD

Julio Teixeria, MD

Andrew Wright, MD

Marc Zerey, MD

William Richardson, MD, Co-Chair

Robert Fanelli, MD, Chair

It was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), January 2010.

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    Tel.: +1 310 437 0544

    Fax: +1 310 437 0585

    Email: publications@sages.org

    Web: http://www.sages.org/

    This is a revision of a SAGES publication, which was printed November 2002.

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Overby, D.W., Apelgren, K.N., Richardson, W. et al. SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surg Endosc 24, 2368–2386 (2010). https://doi.org/10.1007/s00464-010-1268-7

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