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2026, Number 2

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Cir Gen 2026; 48 (2)

Zero Disruption Policies 2026 of the Mexican Association of General Surgery (PDC2026): A best practice guideline for cholecystectomy without biliovascular disruption

Loera-Torres MA, Ordóñez-Gutiérrez ME, Beristain-Hernández JL, Moreno-Paquentín E, Chapa-Azuela O, Ortiz-Higareda V, Noyola-Villalobos H, Martínez-Abundis R, Sánchez-Reyes K, López-Gavito E, Velázquez-Fernández D

Language: Spanish
References: 95
Page: 112-133
PDF size: 1025.56 Kb.


ABSTRACT

Zero Disruption Policy 2026 (PDC2026) of the Mexican Association of General Surgery, proposes a best-practice guideline aimed at minimizing biliovascular disruption during cholecystectomy. Bile duct disruption is one of the most severe complications in abdominal surgery, with significant clinical, economic, emotional, and medical-legal implications. Its occurrence is not attributable solely to technical inexperience, but also to errors in visual perception and cognitive processing, particularly in scenarios involving inflammation, fibrosis, hostile anatomy, fatigue, or intraoperative stress. PDC2026 integrates 10 axiomatic principles and 22 perioperative directives, designed to transform cholecystectomy into a systematic, reproducible, teachable, auditable, and interoperable process. It is grounded in the existing evidence from the international literature and in guidelines issued by the world’s leading surgical organizations. Its central technical axis is the achievement of the Critical View of Safety (CVS) and the adoption of bailout procedures when it cannot be safely obtained. The model emphasizes preoperative planning, informed consent, risk stratification using the Nassar score, universal adoption of intraoperative grading with the Parkland classification, mandatory use of B-SAFE orientation and the R4U line, strategic surgical pauses, verbal declaration of critical findings, safe use of energy devices, selective intraoperative imaging, and the complementary incorporation of emerging technologies for verification, training, and audit. It also recognizes the physical and mental well-being of the surgical team as an active component of patient safety. Finally, it proposes the Minimum Interoperable Structured Record (MISR) to document the essential variables of the surgical procedure and facilitate continuity of care, audit, and research. In summary, the PDC2026 constitutes a comprehensive surgical safety system whose objective is to prevent improvisation and prioritize the patient’s life over the forced resolution of the surgical problem.


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