2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy
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 perfo...
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-06-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-021-00369-w |
| _version_ | 1831560728835784704 |
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| author | Nicola de’Angelis Fausto Catena Riccardo Memeo Federico Coccolini Aleix Martínez-Pérez Oreste M. Romeo Belinda De Simone Salomone Di Saverio Raffaele Brustia Rami Rhaiem Tullio Piardi Maria Conticchio Francesco Marchegiani Nassiba Beghdadi Fikri M. Abu-Zidan Ruslan Alikhanov Marc-Antoine Allard Niccolò Allievi Giuliana Amaddeo Luca Ansaloni Roland Andersson Enrico Andolfi Mohammad Azfar Miklosh Bala Amine Benkabbou Offir Ben-Ishay Giorgio Bianchi Walter L. Biffl Francesco Brunetti Maria Clotilde Carra Daniel Casanova Valerio Celentano Marco Ceresoli Osvaldo Chiara Stefania Cimbanassi Roberto Bini Raul Coimbra Gian Luigi de’Angelis Francesco Decembrino Andrea De Palma Philip R. de Reuver Carlos Domingo Christian Cotsoglou Alessandro Ferrero Gustavo P. Fraga Federica Gaiani Federico Gheza Angela Gurrado Ewen Harrison Angel Henriquez Stefan Hofmeyr Roberta Iadarola Jeffry L. Kashuk Reza Kianmanesh Andrew W. Kirkpatrick Yoram Kluger Filippo Landi Serena Langella Real Lapointe Bertrand Le Roy Alain Luciani Fernando Machado Umberto Maggi Ronald V. Maier Alain Chichom Mefire Kazuhiro Hiramatsu Carlos Ordoñez Franca Patrizi Manuel Planells Andrew B. Peitzman Juan Pekolj Fabiano Perdigao Bruno M. Pereira Patrick Pessaux Michele Pisano Juan Carlos Puyana Sandro Rizoli Luca Portigliotti Raffaele Romito Boris Sakakushev Behnam Sanei Olivier Scatton Mario Serradilla-Martin Anne-Sophie Schneck Mohammed Lamine Sissoko Iradj Sobhani Richard P. ten Broek Mario Testini Roberto Valinas Giorgos Veloudis Giulio Cesare Vitali Dieter Weber Luigi Zorcolo Felice Giuliante Paschalis Gavriilidis David Fuks Daniele Sommacale |
| author_facet | Nicola de’Angelis Fausto Catena Riccardo Memeo Federico Coccolini Aleix Martínez-Pérez Oreste M. Romeo Belinda De Simone Salomone Di Saverio Raffaele Brustia Rami Rhaiem Tullio Piardi Maria Conticchio Francesco Marchegiani Nassiba Beghdadi Fikri M. Abu-Zidan Ruslan Alikhanov Marc-Antoine Allard Niccolò Allievi Giuliana Amaddeo Luca Ansaloni Roland Andersson Enrico Andolfi Mohammad Azfar Miklosh Bala Amine Benkabbou Offir Ben-Ishay Giorgio Bianchi Walter L. Biffl Francesco Brunetti Maria Clotilde Carra Daniel Casanova Valerio Celentano Marco Ceresoli Osvaldo Chiara Stefania Cimbanassi Roberto Bini Raul Coimbra Gian Luigi de’Angelis Francesco Decembrino Andrea De Palma Philip R. de Reuver Carlos Domingo Christian Cotsoglou Alessandro Ferrero Gustavo P. Fraga Federica Gaiani Federico Gheza Angela Gurrado Ewen Harrison Angel Henriquez Stefan Hofmeyr Roberta Iadarola Jeffry L. Kashuk Reza Kianmanesh Andrew W. Kirkpatrick Yoram Kluger Filippo Landi Serena Langella Real Lapointe Bertrand Le Roy Alain Luciani Fernando Machado Umberto Maggi Ronald V. Maier Alain Chichom Mefire Kazuhiro Hiramatsu Carlos Ordoñez Franca Patrizi Manuel Planells Andrew B. Peitzman Juan Pekolj Fabiano Perdigao Bruno M. Pereira Patrick Pessaux Michele Pisano Juan Carlos Puyana Sandro Rizoli Luca Portigliotti Raffaele Romito Boris Sakakushev Behnam Sanei Olivier Scatton Mario Serradilla-Martin Anne-Sophie Schneck Mohammed Lamine Sissoko Iradj Sobhani Richard P. ten Broek Mario Testini Roberto Valinas Giorgos Veloudis Giulio Cesare Vitali Dieter Weber Luigi Zorcolo Felice Giuliante Paschalis Gavriilidis David Fuks Daniele Sommacale |
| author_sort | Nicola de’Angelis |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-17T05:50:58Z |
| format | Article |
| id | doaj.art-ceb1463a4ba34433aebf6cfa3ad13d1c |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-12-17T05:50:58Z |
| publishDate | 2021-06-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-ceb1463a4ba34433aebf6cfa3ad13d1c2022-12-21T22:01:10ZengBMCWorld Journal of Emergency Surgery1749-79222021-06-0116112710.1186/s13017-021-00369-w2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomyNicola de’Angelis0Fausto Catena1Riccardo Memeo2Federico Coccolini3Aleix Martínez-Pérez4Oreste M. Romeo5Belinda De Simone6Salomone Di Saverio7Raffaele Brustia8Rami Rhaiem9Tullio Piardi10Maria Conticchio11Francesco Marchegiani12Nassiba Beghdadi13Fikri M. Abu-Zidan14Ruslan Alikhanov15Marc-Antoine Allard16Niccolò Allievi17Giuliana Amaddeo18Luca Ansaloni19Roland Andersson20Enrico Andolfi21Mohammad Azfar22Miklosh Bala23Amine Benkabbou24Offir Ben-Ishay25Giorgio Bianchi26Walter L. Biffl27Francesco Brunetti28Maria Clotilde Carra29Daniel Casanova30Valerio Celentano31Marco Ceresoli32Osvaldo Chiara33Stefania Cimbanassi34Roberto Bini35Raul Coimbra36Gian Luigi de’Angelis37Francesco Decembrino38Andrea De Palma39Philip R. de Reuver40Carlos Domingo41Christian Cotsoglou42Alessandro Ferrero43Gustavo P. Fraga44Federica Gaiani45Federico Gheza46Angela Gurrado47Ewen Harrison48Angel Henriquez49Stefan Hofmeyr50Roberta Iadarola51Jeffry L. Kashuk52Reza Kianmanesh53Andrew W. Kirkpatrick54Yoram Kluger55Filippo Landi56Serena Langella57Real Lapointe58Bertrand Le Roy59Alain Luciani60Fernando Machado61Umberto Maggi62Ronald V. Maier63Alain Chichom Mefire64Kazuhiro Hiramatsu65Carlos Ordoñez66Franca Patrizi67Manuel Planells68Andrew B. Peitzman69Juan Pekolj70Fabiano Perdigao71Bruno M. Pereira72Patrick Pessaux73Michele Pisano74Juan Carlos Puyana75Sandro Rizoli76Luca Portigliotti77Raffaele Romito78Boris Sakakushev79Behnam Sanei80Olivier Scatton81Mario Serradilla-Martin82Anne-Sophie Schneck83Mohammed Lamine Sissoko84Iradj Sobhani85Richard P. ten Broek86Mario Testini87Roberto Valinas88Giorgos Veloudis89Giulio Cesare Vitali90Dieter Weber91Luigi Zorcolo92Felice Giuliante93Paschalis Gavriilidis94David Fuks95Daniele Sommacale96Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital “F. Miulli”Department of Emergency and Trauma Surgery of the University Hospital of ParmaDepartment of Hepato-Pancreatic-Biliary Surgery, General Regional Hospital “F. Miulli”General, Emergency and Trauma Department, Pisa University HospitalDepartment of General and Digestive Surgery, Hospital Universitario Doctor PesetTrauma, Burn, and Surgical Care Program, Bronson Methodist HospitalService de Chirurgie Générale, Digestive, et Métabolique, Centre hospitalier de Poissy/Saint Germain en LayeDepartment of Surgery, Cambridge University Hospital, NHS Foundation TrustUnit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPECDepartment of HBP and Digestive Oncologic Surgery, Robert Debré University HospitalDepartment of HBP and Digestive Oncologic Surgery, Robert Debré University HospitalDepartment of Hepato-Pancreatic-Biliary Surgery, General Regional Hospital “F. Miulli”Department of Surgical, Oncological and Gastroenterological Sciences, University of PaduaUnit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPECDepartment of Surgery, College of Medicine and Health Sciences, UAE UniversityDepartment of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific CenterCentre Hepatobiliaire, Paul Brousse Hospital1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIIIService d’Hepatologie, APHP, Henri Mondor University Hospital, Creteil, and Faculty of Medicine, University of Paris Est, UPECGeneral Surgery, San Matteo University HospitalDepartment of Surgery, Linkonping UniversityDepartment of Surgery, Division of General Surgery, San Donato HospitalDepartment of Surgery, Al Rahba HospitalTrauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical CenterSurgical Oncology Department, National Institute of Oncology, Mohammed V University in RabatDepartment of General Surgery, Rambam Healthcare CampusUnit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital “F. Miulli”Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La JollaUnit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPECRothschild Hospital, AP-HP, Paris, and Université de ParisHospital Universitario Marqués de Valdecilla, University of CantabriaColorectal Unit, Chelsea and Westminster Hospital, NHS Foundation TrustEmergency and General Surgery Department, University of Milan BicoccaGeneral Surgery and Trauma Team, ASST Niguarda Milano, University of MilanoGeneral Surgery and Trauma Team, ASST Niguarda Milano, University of MilanoGeneral Surgery and Trauma Team, ASST Niguarda Milano, University of MilanoRiverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center – CECORC and Loma Linda University School of MedicineGastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of ParmaGastroenterology and Endoscopy Unit, General Regional Hospital “F. Miulli”General, Emergency and Trauma Department, Pisa University HospitalDepartment of Surgery, Radboud University Medical Centre NijmegenDepartment of General and Digestive Surgery, Hospital Universitario Doctor PesetGeneral Surgery Department, ASST-VimercatDepartment of General and Oncological Surgery, Azienda Ospedaliera Ordine Mauriziano “Umberto I”Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp)Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of ParmaDepartment of Clinical and Experimental Sciences, University of BresciaUnit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”Department of Clinical Surgery and Centre for Medical Informatics, Usher Institute, University of EdinburghCentro Médico LaparoscópicDivision of Surgery, Surgical Gastroenterology Unit, Tygerberg Academic Hospital, University of Stellenbosch Faculty of Medicine and Health SciencesDepartment of Emergency and Trauma Surgery of the University Hospital of ParmaDepartment of Surgery, Tel Aviv University, Sackler School of MedicineDepartment of HBP and Digestive Oncologic Surgery, Robert Debré University HospitalDepartment of Surgery, Critical Care Medicine and the Regional Trauma Service, Foothills Medical CenterDepartment of General Surgery, Rambam Healthcare CampusDepartment of HPB and Transplant Surgery, Hospital Clínic, Universidad de BarcelonaDepartment of General and Oncological Surgery, Azienda Ospedaliera Ordine Mauriziano “Umberto I”Department of HBP Surgery and Liver Transplantation, Department of Surgery, Centre Hospitalier de l’Université de MontrealDepartment of Digestive Surgery, University Hospital of Saint-EtienneUnit of Radiology, Henri Mondor University Hospital (AP-HP), Creteil, and Faculty of Medicine, University of Paris Est, UPECDepartment of Emergency Surgery, Hospital de Clínicas, School of Medicine UDELARGeneral Surgery and Liver Transplantation Unit, Fondazione IRCCS Ca’Granda, Ospedale Maggiore Policlinico di MilanoDepartment of Surgery, University of WashingtonDepartment of Surgery and Obstetrics/Gynecologic, Regional HospitalDepartment of General Surgery, Toyohashi Municipal HospitalDivision of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, Universidad del Valle CaliUnit of Gastroenterology and Endoscopy, Maggiore HospitalDepartment of General and Digestive Surgery, Hospital Universitario Doctor PesetDepartment of Surgery, UPMC, University of Pittsburg, School of MedicineGeneral Surgery, Liver Transplant Unit, Hospital Italiano de Buenos AiresLiver Transplant Unit, APHP, Unité de Chirurgie Hépatobiliaire et Transplantation hépatique, Hôpital Pitié SalpêtrièreDivision of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp)Hepatobiliary and Pancreatic Surgical Unit, Visceral and Digestive Surgery, IHU mix-surg, Institute for Minimally Invasive Image-Guided Surgery, University of Strasbourg1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIIITrauma & Acute Care Surgery – Global Health, University of PittsburghTrauma and Acute Care Service, St Michael’s HospitalChirurgia Epato-Gastro-Pancreatica, Azienda Ospedaliera-Universitaria Maggiore della CaritàChirurgia Epato-Gastro-Pancreatica, Azienda Ospedaliera-Universitaria Maggiore della CaritàGeneral Surgery Department, Medical University, University Hospital St GeorgeDepartment of Surgery, Isfahan University of Medical SciencesLiver Transplant Unit, APHP, Unité de Chirurgie Hépatobiliaire et Transplantation hépatique, Hôpital Pitié SalpêtrièreInstituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel ServetDigestive Surgery Unit, Centre Hospitalier Universitaire de GuadeloupeService de Chirurgie, Hôpital National Blaise Compaoré de OuagadougouDepartment of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, Creteil, and Faculty of Medicine, University of Paris Est, UPECDepartment of Surgery, Radboud University Medical Centre NijmegenUnit of General Surgery “V. Bonomo”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”Department of Surgery “F”, Faculty of Medicine, Clinic Hospital “Dr. Manuel Quintela”Veterans Fund Army HospitalDivision of Transplantation, Department of Surgery, Geneva University HospitalsDepartment of Trauma Surgery, Royal Perth HospitalDepartment of Surgery, Colorectal Surgery Unit, University of CagliariHepatobiliary Surgery Unit, Foundation “Policlinico Universitario A. Gemelli”, IRCCSDivision of Gastrointestinal and HBP Surgery, Imperial College HealthCare, NHS Trust, Hammersmith HospitalInstitut Mutualiste MontsourisUnit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPECAbstract 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.https://doi.org/10.1186/s13017-021-00369-wLaparoscopic cholecystectomyBiliary duct injuryMagnetic resonance imagingAntibiotic therapyComputed tomographyGuidelines |
| spellingShingle | Nicola de’Angelis Fausto Catena Riccardo Memeo Federico Coccolini Aleix Martínez-Pérez Oreste M. Romeo Belinda De Simone Salomone Di Saverio Raffaele Brustia Rami Rhaiem Tullio Piardi Maria Conticchio Francesco Marchegiani Nassiba Beghdadi Fikri M. Abu-Zidan Ruslan Alikhanov Marc-Antoine Allard Niccolò Allievi Giuliana Amaddeo Luca Ansaloni Roland Andersson Enrico Andolfi Mohammad Azfar Miklosh Bala Amine Benkabbou Offir Ben-Ishay Giorgio Bianchi Walter L. Biffl Francesco Brunetti Maria Clotilde Carra Daniel Casanova Valerio Celentano Marco Ceresoli Osvaldo Chiara Stefania Cimbanassi Roberto Bini Raul Coimbra Gian Luigi de’Angelis Francesco Decembrino Andrea De Palma Philip R. de Reuver Carlos Domingo Christian Cotsoglou Alessandro Ferrero Gustavo P. Fraga Federica Gaiani Federico Gheza Angela Gurrado Ewen Harrison Angel Henriquez Stefan Hofmeyr Roberta Iadarola Jeffry L. Kashuk Reza Kianmanesh Andrew W. Kirkpatrick Yoram Kluger Filippo Landi Serena Langella Real Lapointe Bertrand Le Roy Alain Luciani Fernando Machado Umberto Maggi Ronald V. Maier Alain Chichom Mefire Kazuhiro Hiramatsu Carlos Ordoñez Franca Patrizi Manuel Planells Andrew B. Peitzman Juan Pekolj Fabiano Perdigao Bruno M. Pereira Patrick Pessaux Michele Pisano Juan Carlos Puyana Sandro Rizoli Luca Portigliotti Raffaele Romito Boris Sakakushev Behnam Sanei Olivier Scatton Mario Serradilla-Martin Anne-Sophie Schneck Mohammed Lamine Sissoko Iradj Sobhani Richard P. ten Broek Mario Testini Roberto Valinas Giorgos Veloudis Giulio Cesare Vitali Dieter Weber Luigi Zorcolo Felice Giuliante Paschalis Gavriilidis David Fuks Daniele Sommacale 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy World Journal of Emergency Surgery Laparoscopic cholecystectomy Biliary duct injury Magnetic resonance imaging Antibiotic therapy Computed tomography Guidelines |
| title | 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy |
| title_full | 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy |
| title_fullStr | 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy |
| title_full_unstemmed | 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy |
| title_short | 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy |
| title_sort | 2020 wses guidelines for the detection and management of bile duct injury during cholecystectomy |
| topic | Laparoscopic cholecystectomy Biliary duct injury Magnetic resonance imaging Antibiotic therapy Computed tomography Guidelines |
| url | https://doi.org/10.1186/s13017-021-00369-w |
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2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy AT iradjsobhani 2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy AT richardptenbroek 2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy AT mariotestini 2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy AT robertovalinas 2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy AT giorgosveloudis 2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy AT giuliocesarevitali 2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy AT dieterweber 2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy AT luigizorcolo 2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy AT felicegiuliante 2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy AT paschalisgavriilidis 2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy AT davidfuks 2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy AT danielesommacale 2020wsesguidelinesforthedetectionandmanagementofbileductinjuryduringcholecystectomy |