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      2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

      review-article
      1 , 2 , , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 2 , 10 , 10 , 11 , 4 , 12 , 2 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 1 , 25 , 2 , 26 , 27 , 28 , 29 , 30 , 30 , 30 , 31 , 32 , 33 , 5 , 34 , 6 , 35 , 36 , 37 , 32 , 38 , 39 , 40 , 41 , 42 , 3 , 43 , 10 , 44 , 24 , 45 , 36 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 6 , 56 , 57 , 58 , 37 , 59 , 16 , 60 , 61 , 62 , 62 , 63 , 64 , 58 , 65 , 66 , 67 , 68 , 34 , 39 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 2
      World Journal of Emergency Surgery : WJES
      BioMed Central
      Laparoscopic cholecystectomy, Biliary duct injury, Magnetic resonance imaging, Antibiotic therapy, Computed tomography, Guidelines

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          Abstract

          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.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13017-021-00369-w.

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          Sample size calculation in medical studies

          Optimum sample size is an essential component of any research. The main purpose of the sample size calculation is to determine the number of samples needed to detect significant changes in clinical parameters, treatment effects or associations after data gathering. It is not uncommon for studies to be underpowered and thereby fail to detect the existing treatment effects due to inadequate sample size. In this paper, we explain briefly the basic principles of sample size calculations in medical studies.
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            The Surviving Sepsis Campaign Bundle: 2018 update

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              Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

              Background and aims Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. Methods This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. Conclusions The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.

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                valeriocelentano@yahoo.it
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                stefania.cimbanassi@ospedaleniguarda.it
                roberto.bini@ospedaleniguarda.it
                raulcoimbra62@yahoo.com , r.coimbra@ruhealth.org
                gianluigi.deangelis@unipr.it
                francesco.decembrino@gmail.com
                and.dp@hotmail.it
                philip.dereuver@radboudumc.nl
                domingocarlos@hotmail.com
                christian.cotsoglou@asst-vimeracte.it
                aferrero@mauriziano.it
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                stefhofmyr@sun.ac.za
                roberaiadarola@gmail.com
                jeffrykashuk@gmail.com
                reza.kianmanesh@gmail.com
                andrew.kirkpatrick@albertahealthservices.ca
                y_kluger@rambam.health.gov.il
                pippo.landi@gmail.com
                slangella@mauriziano.it
                real.lapointe@umontreal.ca
                leroybertrand8@gmail.com
                alain.luciani@aphp.fr
                fermac08@gmail.com
                maggi.umberto@gmail.com
                ronmaier@uw.edu
                alainchichom@yahoo.com
                kazuhirohiramatsumd@yahoo.co.jp
                ordonezcarlosa@gmail.com
                franca.patrizi@ausl.bologna.it
                planells_mvi@gva.es
                peitzmanab@upmc.edu
                juan.pekolj@hosptalitaliano.org.ar
                fabiano.perdigao@aphp.fr
                drbrunompereira@gmail.com
                patrick.pessaux@chru-strasbourg.gr
                mpisano@asst-pg23.it
                puyajc@upmc.edu
                rizolis@smh.ca
                portigliotti.luca@gmail.com
                raffaele.romito@maggioreosp.novara.it
                bsakakushev@gmail.com
                behnam.sanei49@gmail.com
                olivier.scatton@aphp.fr
                marioserradilla@hotmail.com
                escargot2@yahoo.com
                mlsissoko1974@yahoo.fr
                iradj.sobhani@aphp.fr
                richard.tenbroek@radboudumc.nl
                mario.testini@uniba.it
                rvalinas@adnet.com.uy
                gveloudis@hotmail.com
                giuliocesare.vitale@gmail.com
                dietergweber@gmail.com
                gizorcolo@hotmail.com
                felice.giuliante@policlinicogemelli.it
                pgavrielidis@yahoo.com
                david.fuks@imm.fr
                daniele.sommacale@aphp.fr
                Journal
                World J Emerg Surg
                World J Emerg Surg
                World Journal of Emergency Surgery : WJES
                BioMed Central (London )
                1749-7922
                10 June 2021
                10 June 2021
                2021
                : 16
                : 30
                Affiliations
                [1 ]Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital “F. Miulli”, Strada Prov. 127 Acquaviva – Santeramo Km. 4, 70021 Acquaviva delle Fonti BA, Bari, Italy
                [2 ]GRID grid.410511.0, ISNI 0000 0001 2149 7878, Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, , University of Paris Est, UPEC, ; Creteil, France
                [3 ]GRID grid.411482.a, Department of Emergency and Trauma Surgery of the University Hospital of Parma, ; Parma, Italy
                [4 ]Department of Hepato-Pancreatic-Biliary Surgery, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, Bari, Italy
                [5 ]GRID grid.144189.1, ISNI 0000 0004 1756 8209, General, Emergency and Trauma Department, , Pisa University Hospital, ; Pisa, Italy
                [6 ]GRID grid.411289.7, ISNI 0000 0004 1770 9825, Department of General and Digestive Surgery, , Hospital Universitario Doctor Peset, ; Valencia, Spain
                [7 ]GRID grid.414632.6, ISNI 0000 0004 0437 865X, Trauma, Burn, and Surgical Care Program, , Bronson Methodist Hospital, ; Kalamazoo, Michigan USA
                [8 ]GRID grid.418056.e, ISNI 0000 0004 1765 2558, Service de Chirurgie Générale, Digestive, et Métabolique, Centre hospitalier de Poissy/Saint Germain en Laye, ; Saint Germain en Laye, France
                [9 ]GRID grid.451052.7, ISNI 0000 0004 0581 2008, Department of Surgery, Cambridge University Hospital, , NHS Foundation Trust, ; Cambridge, UK
                [10 ]GRID grid.413235.2, ISNI 0000 0004 1937 0589, Department of HBP and Digestive Oncologic Surgery, , Robert Debré University Hospital, ; Reims, France
                [11 ]Department of Surgery, HPB Unit, Troyes Hospital, Troyes, France
                [12 ]GRID grid.5608.b, ISNI 0000 0004 1757 3470, Department of Surgical, Oncological and Gastroenterological Sciences, , University of Padua, ; Padua, Italy
                [13 ]GRID grid.43519.3a, ISNI 0000 0001 2193 6666, Department of Surgery, College of Medicine and Health Sciences, , UAE University, ; Al-Ain, United Arab Emirates
                [14 ]GRID grid.477594.c, ISNI 0000 0004 4687 8943, Department of Hepato-Pancreato-Biliary Surgery, , Moscow Clinical Scientific Center, ; Shosse Enthusiastov, 86, 111123 Moscow, Russia
                [15 ]GRID grid.413133.7, ISNI 0000 0001 0206 8146, Centre Hepatobiliaire, , Paul Brousse Hospital, ; Villejuif, France
                [16 ]1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
                [17 ]GRID grid.410511.0, ISNI 0000 0001 2149 7878, Service d’Hepatologie, APHP, Henri Mondor University Hospital, Creteil, and Faculty of Medicine, , University of Paris Est, UPEC, ; Creteil, France
                [18 ]GRID grid.18887.3e, ISNI 0000000417581884, General Surgery, , San Matteo University Hospital, ; Pavia, Italy
                [19 ]Department of Surgery, Linkonping University, Linkoping, Sweden
                [20 ]GRID grid.416351.4, ISNI 0000 0004 1789 6237, Department of Surgery, Division of General Surgery, , San Donato Hospital, ; 52100 Arezzo, Italy
                [21 ]Department of Surgery, Al Rahba Hospital, Abu Dhabi, UAE
                [22 ]GRID grid.17788.31, ISNI 0000 0001 2221 2926, Trauma and Acute Care Surgery Unit, , Hadassah Hebrew University Medical Center, ; Jerusalem, Israel
                [23 ]GRID grid.31143.34, ISNI 0000 0001 2168 4024, Surgical Oncology Department, National Institute of Oncology, , Mohammed V University in Rabat, ; Rabat, Morocco
                [24 ]Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
                [25 ]GRID grid.415402.6, ISNI 0000 0004 0449 3295, Division of Trauma and Acute Care Surgery, , Scripps Memorial Hospital La Jolla, ; La Jolla, California USA
                [26 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, Rothschild Hospital, AP-HP, Paris, and Université de Paris, ; Paris, France
                [27 ]GRID grid.7821.c, ISNI 0000 0004 1770 272X, Hospital Universitario Marqués de Valdecilla, University of Cantabria, ; Santander, Spain
                [28 ]GRID grid.428062.a, ISNI 0000 0004 0497 2835, Colorectal Unit, , Chelsea and Westminster Hospital, NHS Foundation Trust, ; London, UK
                [29 ]GRID grid.7563.7, ISNI 0000 0001 2174 1754, Emergency and General Surgery Department, , University of Milan Bicocca, ; Milan, Italy
                [30 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, General Surgery and Trauma Team, ASST Niguarda Milano, , University of Milano, ; Milan, Italy
                [31 ]GRID grid.43582.38, ISNI 0000 0000 9852 649X, Riverside University Health System Medical Center, , Comparative Effectiveness and Clinical Outcomes Research Center – CECORC and Loma Linda University School of Medicine, ; Loma Linda, USA
                [32 ]GRID grid.10383.39, ISNI 0000 0004 1758 0937, Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, , University of Parma, ; Parma, Italy
                [33 ]Gastroenterology and Endoscopy Unit, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, Bari, Italy
                [34 ]GRID grid.10417.33, ISNI 0000 0004 0444 9382, Department of Surgery, , Radboud University Medical Centre Nijmegen, ; Nijmegen, The Netherlands
                [35 ]General Surgery Department, ASST-Vimercat, 20871 Vimercate, Italy
                [36 ]GRID grid.414700.6, ISNI 0000 0004 0484 5983, Department of General and Oncological Surgery, , Azienda Ospedaliera Ordine Mauriziano “Umberto I”, ; Turin, Italy
                [37 ]GRID grid.411087.b, ISNI 0000 0001 0723 2494, Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, , University of Campinas (Unicamp), ; Campinas, SP Brazil
                [38 ]GRID grid.7637.5, ISNI 0000000417571846, Department of Clinical and Experimental Sciences, , University of Brescia, ; Brescia, Italy
                [39 ]GRID grid.7644.1, ISNI 0000 0001 0120 3326, Unit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, , University of Bari “Aldo Moro”, ; Bari, Italy
                [40 ]GRID grid.4305.2, ISNI 0000 0004 1936 7988, Department of Clinical Surgery and Centre for Medical Informatics, Usher Institute, , University of Edinburgh, ; Little France Crescent, Edinburgh, UK
                [41 ]Centro Médico Laparoscópic, San Salvador, El Salvador
                [42 ]GRID grid.11956.3a, ISNI 0000 0001 2214 904X, Division of Surgery, Surgical Gastroenterology Unit, Tygerberg Academic Hospital, , University of Stellenbosch Faculty of Medicine and Health Sciences, ; Stellenbosch, South Africa
                [43 ]GRID grid.12136.37, ISNI 0000 0004 1937 0546, Department of Surgery, , Tel Aviv University, Sackler School of Medicine, ; Tel Aviv, Israel
                [44 ]GRID grid.414959.4, ISNI 0000 0004 0469 2139, Department of Surgery, Critical Care Medicine and the Regional Trauma Service, , Foothills Medical Center, ; Calgari, Alberta Canada
                [45 ]GRID grid.5841.8, ISNI 0000 0004 1937 0247, Department of HPB and Transplant Surgery, Hospital Clínic, , Universidad de Barcelona, ; Barcelona, Spain
                [46 ]GRID grid.410559.c, ISNI 0000 0001 0743 2111, Department of HBP Surgery and Liver Transplantation, Department of Surgery, , Centre Hospitalier de l’Université de Montreal, ; Montreal, QC Canada
                [47 ]GRID grid.412954.f, ISNI 0000 0004 1765 1491, Department of Digestive Surgery, , University Hospital of Saint-Etienne, ; Saint-Priest-en-Jarez, France
                [48 ]GRID grid.410511.0, ISNI 0000 0001 2149 7878, Unit of Radiology, Henri Mondor University Hospital (AP-HP), Creteil, and Faculty of Medicine, , University of Paris Est, UPEC, ; Creteil, France
                [49 ]GRID grid.11630.35, ISNI 0000000121657640, Department of Emergency Surgery, Hospital de Clínicas, , School of Medicine UDELAR, ; Montevideo, Uruguay
                [50 ]GRID grid.414818.0, ISNI 0000 0004 1757 8749, General Surgery and Liver Transplantation Unit, Fondazione IRCCS Ca’Granda, , Ospedale Maggiore Policlinico di Milano, ; Milan, Italy
                [51 ]GRID grid.34477.33, ISNI 0000000122986657, Department of Surgery, , University of Washington, ; Seattle, WA USA
                [52 ]Department of Surgery and Obstetrics/Gynecologic, Regional Hospital, Limbe, Cameroon
                [53 ]GRID grid.417241.5, ISNI 0000 0004 1772 7556, Department of General Surgery, , Toyohashi Municipal Hospital, ; Toyohashi, Aichi Japan
                [54 ]GRID grid.8271.c, ISNI 0000 0001 2295 7397, Division of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, , Universidad del Valle Cali, ; Cali, Colombia
                [55 ]GRID grid.416290.8, ISNI 0000 0004 1759 7093, Unit of Gastroenterology and Endoscopy, , Maggiore Hospital, ; Bologna, Italy
                [56 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, Department of Surgery, UPMC, , University of Pittsburg, School of Medicine, ; Pittsburg, USA
                [57 ]GRID grid.414775.4, ISNI 0000 0001 2319 4408, General Surgery, Liver Transplant Unit, , Hospital Italiano de Buenos Aires, ; Buenos Aires, Argentina
                [58 ]GRID grid.411439.a, ISNI 0000 0001 2150 9058, Liver Transplant Unit, APHP, Unité de Chirurgie Hépatobiliaire et Transplantation hépatique, , Hôpital Pitié Salpêtrière, ; Paris, France
                [59 ]GRID grid.11843.3f, ISNI 0000 0001 2157 9291, Hepatobiliary and Pancreatic Surgical Unit, Visceral and Digestive Surgery, IHU mix-surg, Institute for Minimally Invasive Image-Guided Surgery, , University of Strasbourg, ; Strasbourg, France
                [60 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, Trauma & Acute Care Surgery – Global Health, , University of Pittsburgh, ; Pittsburgh, USA
                [61 ]GRID grid.415502.7, Trauma and Acute Care Service, , St Michael’s Hospital, ; Toronto, ON Canada
                [62 ]GRID grid.412824.9, ISNI 0000 0004 1756 8161, Chirurgia Epato-Gastro-Pancreatica, , Azienda Ospedaliera-Universitaria Maggiore della Carità, ; Novara, Italy
                [63 ]GRID grid.35371.33, ISNI 0000 0001 0726 0380, General Surgery Department, , Medical University, University Hospital St George, ; Plovdiv, Bulgaria
                [64 ]GRID grid.411036.1, ISNI 0000 0001 1498 685X, Department of Surgery, , Isfahan University of Medical Sciences, ; Isfahan, Iran
                [65 ]GRID grid.411106.3, ISNI 0000 0000 9854 2756, Instituto de Investigación Sanitaria Aragón, Department of Surgery, , Hospital Universitario Miguel Servet, ; Zaragoza, Spain
                [66 ]Digestive Surgery Unit, Centre Hospitalier Universitaire de Guadeloupe, Pointe-À-Pitre, Les Avymes, Guadeloupe France
                [67 ]Service de Chirurgie, Hôpital National Blaise Compaoré de Ouagadougou, Ouagadougou, Burkina Faso
                [68 ]GRID grid.410511.0, ISNI 0000 0001 2149 7878, Department of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, Creteil, and Faculty of Medicine, , University of Paris Est, UPEC, ; Creteil, France
                [69 ]Department of Surgery “F”, Faculty of Medicine, Clinic Hospital “Dr. Manuel Quintela”, Montevideo, Uruguay
                [70 ]Veterans Fund Army Hospital, Athens, Greece
                [71 ]GRID grid.150338.c, ISNI 0000 0001 0721 9812, Division of Transplantation, Department of Surgery, , Geneva University Hospitals, ; Geneva, Switzerland
                [72 ]GRID grid.416195.e, ISNI 0000 0004 0453 3875, Department of Trauma Surgery, , Royal Perth Hospital, ; Perth, Australia
                [73 ]GRID grid.7763.5, ISNI 0000 0004 1755 3242, Department of Surgery, Colorectal Surgery Unit, , University of Cagliari, ; Cagliari, Italy
                [74 ]GRID grid.414603.4, Hepatobiliary Surgery Unit, Foundation “Policlinico Universitario A. Gemelli”, , IRCCS, ; Rome, Italy
                [75 ]GRID grid.413629.b, ISNI 0000 0001 0705 4923, Division of Gastrointestinal and HBP Surgery, Imperial College HealthCare, NHS Trust, , Hammersmith Hospital, ; London, UK
                [76 ]GRID grid.418120.e, ISNI 0000 0001 0626 5681, Institut Mutualiste Montsouris, ; Paris, France
                Author information
                http://orcid.org/0000-0002-1211-4916
                Article
                369
                10.1186/s13017-021-00369-w
                8190978
                34112197
                d965f052-7d4e-40a8-83ce-4eee6c429092
                © The Author(s) 2021

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                History
                : 27 January 2021
                : 18 May 2021
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                Review
                Custom metadata
                © The Author(s) 2021

                Surgery
                laparoscopic cholecystectomy,biliary duct injury,magnetic resonance imaging,antibiotic therapy,computed tomography,guidelines

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