SAGES-AHPBA 2025 guideline for the surgical management of bile duct injury following cholecystectomy

BackgroundBile duct injury (BDI) following cholecystectomy is a complication associated with significant morbidity and mortality. This guideline addresses timing and type of repair following injury to improve patient outcomes and surgical decision-making.MethodologyA systematic review was carried out, including a literature search up to December 31, 2024 addressing four key questions regarding the definitive repair of BDI following cholecystectomy. The findings were subsequently presented to a panel of surgeons from both the Society of American Gastrointestinal and Endoscopic Surgeons and the American (SAGES) and the Americas Hepato-Pancreato-Biliary Association (AHPBA). Subject matter experts then used the GRADE methodology to develop evidence-based recommendations.ResultsA conditional recommendation, with low certainty of evidence, in favor of delayed (> 6 weeks) versus early definitive repair (< 6 weeks) of BDI was made. A conditional recommendation for either minimally invasive or open repair was made based on very low certainty of evidence. A conditional recommendation was made for either the nonoperative or operative definitive repair of BDI based on very low certainty of evidence. Finally, a conditional recommendation was made for either hepaticoduodenostomy or hepaticojejunostomy as a bilioenteric anastomosis approach following BDI based on very low certainty of evidence.ConclusionThese recommendations provide guidance for the approach to repair of BDI following cholecystectomy according to the existing literature and expert input. The panel also highlighted evidence gaps to support future research for a stronger evidence base around BDI repair.