const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// Fetch images as base64
const imageUrls = [
  "https://cdn.orris.care/cdss_images/BAILY_1760532652473_86d2d620-07e3-47b2-815a-0724c22dd5a3.png",
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_cf141f5bb2761a46b4cbc38dbcb441acbe311007eedc3e6ac18d21a26db2e4d2.jpg",
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_d0a23b62e802060232314d7ecdae4547ea40e4467397d58ca1b7c78f3fc86627.jpg",
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_1e85fb83ecdf0f535f383e3eedc56c72717b662cab7986297849afdfd2ffbe64.jpg",
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_6d70d692d9759a77f80da024a0a5cfa622d8c5a3a31b43a4cf1783ee8677a1cb.jpg"
];

let images = [];
try {
  const result = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`,
    { maxBuffer: 50 * 1024 * 1024 }
  ).toString();
  images = JSON.parse(result);
  console.log("Images fetched:", images.map(i => i.error ? "ERROR: " + i.error : "OK").join(", "));
} catch (e) {
  console.error("Image fetch error:", e.message);
  images = imageUrls.map(url => ({ url, base64: null, error: e.message }));
}

const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE";
pres.title = "Iatrogenic Bile Duct Injuries";
pres.author = "General Surgery Grand Rounds";

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
const DEEP_NAVY   = "0A1F44";   // dominant background
const MED_BLUE    = "1A3D6E";   // section headers / shapes
const ACCENT_GOLD = "E8A020";   // accent / highlights
const LIGHT_GRAY  = "EEF2F7";   // text-area backgrounds
const WHITE       = "FFFFFF";
const RED_ALERT   = "C0392B";   // danger / alert callouts
const TEAL        = "1ABC9C";   // positive/safe steps

// ─── HELPERS ─────────────────────────────────────────────────────────────────
function titleSlide(slide) {
  // Full background
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DEEP_NAVY } });
  // Gold accent bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 5.5, w: 13.3, h: 0.12, fill: { color: ACCENT_GOLD } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 6.8, w: 13.3, h: 0.7, fill: { color: MED_BLUE } });
}

function sectionBg(slide) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: DEEP_NAVY } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.15, h: 7.5, fill: { color: ACCENT_GOLD } });
}

function contentBg(slide) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: LIGHT_GRAY } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 1.05, fill: { color: DEEP_NAVY } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 1.05, w: 13.3, h: 0.06, fill: { color: ACCENT_GOLD } });
}

function addHeader(slide, title, subtitle) {
  contentBg(slide);
  slide.addText(title, {
    x: 0.3, y: 0.1, w: 12.7, h: 0.75,
    fontSize: 24, bold: true, color: WHITE, fontFace: "Calibri", align: "left", margin: 0
  });
  if (subtitle) {
    slide.addText(subtitle, {
      x: 0.3, y: 0.78, w: 12.7, h: 0.32,
      fontSize: 13, color: ACCENT_GOLD, fontFace: "Calibri", italic: true, margin: 0
    });
  }
}

function addBullets(slide, items, x, y, w, h, opts) {
  const o = opts || {};
  const fontSize = o.fontSize || 16;
  const textItems = items.map((item, idx) => {
    if (typeof item === "string") {
      return { text: item, options: { bullet: true, breakLine: idx < items.length - 1, fontSize, color: o.color || "1A1A2E", fontFace: "Calibri", paraSpaceAfter: 4 } };
    } else {
      return { text: item.text, options: { bullet: item.sub ? { indent: 25 } : true, breakLine: idx < items.length - 1, fontSize: item.sub ? fontSize - 2 : fontSize, color: item.color || o.color || "1A1A2E", fontFace: "Calibri", bold: item.bold || false, paraSpaceAfter: 3 } };
    }
  });
  slide.addText(textItems, { x, y, w, h, valign: "top", margin: 6 });
}

function calloutBox(slide, text, x, y, w, h, color) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h,
    fill: { color: color || ACCENT_GOLD },
    line: { color: WHITE, width: 1 },
    rectRadius: 0.08
  });
  slide.addText(text, {
    x: x + 0.1, y: y + 0.05, w: w - 0.2, h: h - 0.1,
    fontSize: 13, color: WHITE, bold: true, fontFace: "Calibri", align: "center", valign: "middle"
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  titleSlide(s);

  // Decorative circle
  s.addShape(pres.ShapeType.ellipse, { x: 9.5, y: -1.5, w: 6, h: 6, fill: { color: MED_BLUE }, line: { color: MED_BLUE } });
  s.addShape(pres.ShapeType.ellipse, { x: 10, y: -1, w: 5, h: 5, fill: { color: "0D2550" }, line: { color: "0D2550" } });

  s.addText("IATROGENIC", {
    x: 0.8, y: 0.8, w: 9, h: 0.9,
    fontSize: 48, bold: true, color: ACCENT_GOLD, fontFace: "Calibri", charSpacing: 6, margin: 0
  });
  s.addText("BILE DUCT INJURIES", {
    x: 0.8, y: 1.65, w: 9, h: 0.9,
    fontSize: 44, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });
  s.addShape(pres.ShapeType.rect, { x: 0.8, y: 2.65, w: 6.5, h: 0.06, fill: { color: ACCENT_GOLD } });
  s.addText("A Comprehensive Review: Classification | Mechanisms | Prevention | Management | Outcomes", {
    x: 0.8, y: 2.85, w: 10, h: 0.6,
    fontSize: 16, color: "B8C8E0", fontFace: "Calibri", italic: true, margin: 0
  });
  s.addText("Sources: Sabiston Textbook of Surgery | Current Surgical Therapy 14e | Mulholland & Greenfield 7e\nSAGES-AHPBA 2025 Guideline | Surg Endosc 2026", {
    x: 0.8, y: 3.65, w: 10, h: 0.8,
    fontSize: 13, color: "8899BB", fontFace: "Calibri", margin: 0
  });
  s.addText("General Surgery Grand Rounds  •  2026", {
    x: 0.5, y: 6.85, w: 12, h: 0.45,
    fontSize: 13, color: "AABBCC", fontFace: "Calibri", align: "center", margin: 0
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — SCOPE & OUTLINE
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Presentation Outline", "Structured for clinical understanding and surgical decision-making");
  const topics = [
    "1.  Scope of the Problem & Epidemiology",
    "2.  Surgical Anatomy & Mechanism of Injury",
    "3.  Risk Factors",
    "4.  Classification Systems (Bismuth, Strasberg, Stewart-Way)",
    "5.  Prevention — Critical View of Safety & IOC",
    "6.  Clinical Presentation & Diagnosis",
    "7.  Intraoperative Recognition",
    "8.  Postoperative Workup (Labs, Imaging, ERCP, PTC)",
    "9.  Management Principles",
    "10. Timing of Repair (SAGES-AHPBA 2025 Guideline)",
    "11. Surgical Repair Techniques",
    "12. Non-operative & Endoscopic Management",
    "13. Outcomes & Long-term Follow-up",
    "14. Medicolegal Considerations",
    "15. Key Takeaways",
  ];
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.2, w: 6.1, h: 5.9, fill: { color: WHITE }, line: { color: "CCDDEE", width: 1 } });
  s.addShape(pres.ShapeType.rect, { x: 6.7, y: 1.2, w: 6.1, h: 5.9, fill: { color: WHITE }, line: { color: "CCDDEE", width: 1 } });
  const left = topics.slice(0, 8);
  const right = topics.slice(8);
  addBullets(s, left, 0.35, 1.25, 5.9, 5.8, { fontSize: 14, color: DEEP_NAVY });
  addBullets(s, right, 6.8, 1.25, 5.9, 5.8, { fontSize: 14, color: DEEP_NAVY });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — EPIDEMIOLOGY
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Scope of the Problem", "Epidemiology & Public Health Impact");

  // Stat boxes
  const stats = [
    { val: "0.1–0.6%", label: "Incidence\nLaparoscopic" },
    { val: "0.1%", label: "Incidence\nOpen" },
    { val: "~1M", label: "Cholecystectomies\nper year (USA)" },
    { val: "1 in 3", label: "Surgeons will cause\na BDI in career" },
  ];
  stats.forEach((st, i) => {
    const x = 0.35 + i * 3.2;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.2, w: 2.9, h: 1.6, fill: { color: DEEP_NAVY }, line: { color: ACCENT_GOLD, width: 2 }, rectRadius: 0.1 });
    s.addText(st.val, { x: x + 0.1, y: 1.25, w: 2.7, h: 0.9, fontSize: 28, bold: true, color: ACCENT_GOLD, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(st.label, { x: x + 0.1, y: 2.1, w: 2.7, h: 0.6, fontSize: 12, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle" });
  });

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 3.0, w: 12.8, h: 4.1, fill: { color: WHITE }, line: { color: "CCDDEE", width: 1 } });

  const bullets = [
    { text: ">80% of all bile duct injuries occur during cholecystectomy", bold: true },
    "Laparoscopic cholecystectomy: incidence 0.1–0.6% (open: ~0.1%)",
    "Increased incidence at introduction of laparoscopic era (early 1990s); improved with experience",
    { text: "New data suggest robotic cholecystectomy may have higher BDI rate than laparoscopic", bold: true, color: RED_ALERT },
    "BDI causes: significant morbidity, reduced quality of life, financial burden, malpractice claims, mortality",
    "Benign biliary strictures can also arise from: inflammatory disease, gallstones, non-iatrogenic trauma",
    { text: "Key principle: Misperception of anatomy is more common than surgical skill failure", bold: true, color: MED_BLUE },
  ];
  addBullets(s, bullets, 0.4, 3.05, 12.5, 4.0, { fontSize: 15, color: "1A1A2E" });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — ANATOMY & MECHANISMS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Mechanism of Injury", "Why bile duct injuries happen — anatomy and perception");

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.2, w: 7.5, h: 5.9, fill: { color: WHITE }, line: { color: "CCDDEE" } });
  s.addShape(pres.ShapeType.rect, { x: 8.1, y: 1.2, w: 4.9, h: 5.9, fill: { color: MED_BLUE }, line: { color: MED_BLUE } });

  const mechanismBullets = [
    { text: "Classic Mechanism (\"Tenting\" Injury):", bold: true, color: RED_ALERT },
    { text: "Excessive cephalad retraction of fundus → cystic duct aligns parallel to CBD", sub: true },
    { text: "Surgeon misidentifies CBD as cystic duct → clips and divides CBD", sub: true },
    { text: "Confirmation bias prevents intraoperative recognition", sub: true },
    { text: "Factors Contributing to Misidentification:", bold: true, color: MED_BLUE },
    { text: "Insufficient lateral retraction of infundibulum", sub: true },
    { text: "Dissection medial to CBD instead of lateral to cystic duct", sub: true },
    { text: "Laparoscopic 2D vision & restricted field of view", sub: true },
    { text: "Other Mechanisms:", bold: true, color: MED_BLUE },
    { text: "Aberrant biliary anatomy (low cystic duct insertion, parallel course) — up to 25% patients", sub: true },
    { text: "Right posterior sectoral duct draining into CBD — up to 6%", sub: true },
    { text: "Excessive electrocautery → thermal injury → delayed stricture", sub: true },
    { text: "Traction injury; top-down dissection (open surgery)", sub: true },
    { text: "Vasculobiliary injury — right hepatic artery injury increases stricture risk", bold: true, color: RED_ALERT },
  ];
  addBullets(s, mechanismBullets, 0.35, 1.25, 7.3, 5.8, { fontSize: 13.5, color: "1A1A2E" });

  s.addText("DANGER ZONES", { x: 8.2, y: 1.3, w: 4.7, h: 0.45, fontSize: 15, bold: true, color: ACCENT_GOLD, fontFace: "Calibri", align: "center" });
  const dangerItems = [
    "Short / absent cystic duct",
    "Parallel cystic-CBD course",
    "Mirizzi syndrome",
    "Severe acute cholecystitis",
    "Cirrhosis / portal HTN",
    "Prior biliary surgery",
    "Aberrant right hepatic duct",
    "Obesity / difficult exposure",
  ];
  dangerItems.forEach((txt, i) => {
    s.addShape(pres.ShapeType.roundRect, { x: 8.2, y: 1.85 + i * 0.61, w: 4.7, h: 0.52, fill: { color: i % 2 === 0 ? "0D2550" : DEEP_NAVY }, line: { color: ACCENT_GOLD, width: 1 }, rectRadius: 0.05 });
    s.addText("⚠ " + txt, { x: 8.3, y: 1.87 + i * 0.61, w: 4.5, h: 0.48, fontSize: 13, color: WHITE, fontFace: "Calibri", valign: "middle" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — STRASBERG CLASSIFICATION WITH IMAGE
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Classification of Bile Duct Injuries", "Strasberg-Bismuth Classification (most widely used)");

  // Table for classification
  const tableRows = [
    [{ text: "Type", options: { bold: true, color: WHITE, fill: DEEP_NAVY } }, { text: "Description", options: { bold: true, color: WHITE, fill: DEEP_NAVY } }, { text: "Notes", options: { bold: true, color: WHITE, fill: DEEP_NAVY } }],
    ["A", "Bile leak from cystic duct stump or duct of Luschka", "Minor — ERCP ± stent usually curative"],
    ["B", "Occlusion (clip) of aberrant right hepatic duct", "Stricture — often silent, discovered late"],
    ["C", "Transection of aberrant R hepatic duct — bile leak", "Requires bilioenteric anastomosis"],
    ["D", "Lateral injury to main bile duct without tissue loss", "T-tube repair; may be managed endoscopically"],
    ["E1", "CBD stricture >2 cm below bifurcation", "Surgical reconstruction usually needed"],
    ["E2", "CBD stricture <2 cm below bifurcation", "Hepaticojejunostomy preferred"],
    ["E3", "Stricture at confluence — R & L ducts in communication", "More complex repair required"],
    ["E4", "Stricture separating R & L hepatic ducts", "High hilar reconstruction"],
    ["E5", "Injury to aberrant R sectoral duct + main duct", "Two-duct repair"],
  ];

  s.addTable(tableRows, {
    x: 0.25, y: 1.2, w: 7.8, h: 5.9,
    colW: [0.7, 4.5, 2.5],
    fontSize: 12,
    fontFace: "Calibri",
    color: DEEP_NAVY,
    border: { type: "solid", color: "CCDDEE", pt: 1 },
    fill: { color: WHITE },
    rowH: 0.55,
    align: "left",
    valign: "middle",
  });

  if (images[0] && images[0].base64) {
    s.addImage({ data: images[0].base64, x: 8.2, y: 1.2, w: 4.8, h: 5.9 });
  } else {
    s.addShape(pres.ShapeType.rect, { x: 8.2, y: 1.2, w: 4.8, h: 5.9, fill: { color: MED_BLUE } });
    s.addText("Strasberg Classification Diagram\n(Bailey & Love, p.1273)", { x: 8.3, y: 3.2, w: 4.6, h: 1.5, fontSize: 14, color: WHITE, align: "center", valign: "middle" });
  }
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — STEWART-WAY CLASSIFICATION
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Stewart-Way Classification", "Mechanism-based classification — guides intraoperative decision");

  const classes = [
    { cls: "Class I", desc: "CBD incised (not transected); mistaken for cystic duct — incision < circumference", mgmt: "Primary closure ± T-tube" },
    { cls: "Class II", desc: "CHD damaged laterally; mistaken for cystic duct; partial clip / clip + cautery", mgmt: "Repair over stent or hepaticojejunostomy" },
    { cls: "Class III", desc: "CHD transected and excised; CBD mistaken for cystic duct (most common, classic)", mgmt: "Hepaticojejunostomy" },
    { cls: "Class IV", desc: "RHD transected ± CHD; right ductal structures mistaken for cystic duct", mgmt: "Right-sided reconstruction — most complex" },
  ];

  classes.forEach((c, i) => {
    const y = 1.3 + i * 1.45;
    const bg = i % 2 === 0 ? WHITE : "F0F4FA";
    s.addShape(pres.ShapeType.roundRect, { x: 0.25, y, w: 12.8, h: 1.35, fill: { color: bg }, line: { color: "CCDDEE", width: 1 }, rectRadius: 0.07 });
    s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: y + 0.08, w: 1.3, h: 1.1, fill: { color: MED_BLUE }, line: { color: MED_BLUE }, rectRadius: 0.06 });
    s.addText(c.cls, { x: 0.3, y: y + 0.28, w: 1.3, h: 0.7, fontSize: 14, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    s.addText(c.desc, { x: 1.75, y: y + 0.1, w: 8.0, h: 0.65, fontSize: 13.5, color: DEEP_NAVY, fontFace: "Calibri", valign: "middle" });
    s.addShape(pres.ShapeType.roundRect, { x: 10.0, y: y + 0.1, w: 3.0, h: 1.1, fill: { color: DEEP_NAVY }, line: { color: ACCENT_GOLD, width: 1 }, rectRadius: 0.06 });
    s.addText("Repair:\n" + c.mgmt, { x: 10.1, y: y + 0.15, w: 2.8, h: 1.0, fontSize: 11.5, color: WHITE, fontFace: "Calibri", valign: "middle", align: "center" });
  });

  calloutBox(s, "Class III is the most common injury pattern — accounts for ~75% of all laparoscopic BDIs", 0.25, 7.0, 12.8, 0.45, MED_BLUE);
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — PREVENTION: CRITICAL VIEW OF SAFETY (with image)
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Prevention — Critical View of Safety (CVS)", "Strasberg & Soper, 1995 — the single most effective preventive measure");

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.2, w: 6.0, h: 5.9, fill: { color: WHITE }, line: { color: "CCDDEE" } });

  const cvsBullets = [
    { text: "THREE CRITERIA for CVS (ALL must be met):", bold: true, color: DEEP_NAVY },
    { text: "① Hepatocystic triangle completely cleared of fat and fibrous tissue", sub: true, color: TEAL, bold: true },
    { text: "② Lower one-third of gallbladder separated from cystic plate (liver bed)", sub: true, color: TEAL, bold: true },
    { text: "③ Only TWO structures seen entering the gallbladder (cystic duct + cystic artery)", sub: true, color: TEAL, bold: true },
    { text: "Technique:", bold: true },
    { text: "Retract fundus superiorly; Hartmann's pouch laterally and inferiorly", sub: true },
    { text: "Dissect from gallbladder infundibulum — NOT from triangle of Calot directly", sub: true },
    { text: "Initiate dissection lateral to cystic duct to avoid CBD misidentification", sub: true },
    { text: "When CVS Cannot Be Achieved:", bold: true, color: RED_ALERT },
    { text: "Consider subtotal cholecystectomy (fenestrating or reconstituting)", sub: true },
    { text: "Cholecystostomy tube placement", sub: true },
    { text: "Conversion to open — BUT only if surgeon experienced in open CBD surgery", sub: true },
    { text: "Document CVS with intraoperative photograph", bold: true, color: MED_BLUE },
  ];
  addBullets(s, cvsBullets, 0.35, 1.25, 5.8, 5.8, { fontSize: 13.5, color: "1A1A2E" });

  if (images[1] && images[1].base64) {
    s.addImage({ data: images[1].base64, x: 6.5, y: 1.2, w: 6.5, h: 5.9 });
    s.addText("Critical View of Safety — intraoperative CVS with labeled anatomy", { x: 6.5, y: 6.8, w: 6.5, h: 0.3, fontSize: 9, color: MED_BLUE, italic: true, align: "center" });
  } else {
    s.addShape(pres.ShapeType.rect, { x: 6.5, y: 1.2, w: 6.5, h: 5.9, fill: { color: DEEP_NAVY } });
    s.addText("CVS Intraoperative Image", { x: 6.6, y: 3.8, w: 6.3, h: 1, fontSize: 16, color: WHITE, align: "center" });
  }
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — IOC & SUBTOTAL CHOLECYSTECTOMY
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Prevention — IOC & Bailout Strategies", "Intraoperative Cholangiography and Subtotal Cholecystectomy");

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.2, w: 6.2, h: 5.9, fill: { color: WHITE }, line: { color: "CCDDEE" } });
  s.addShape(pres.ShapeType.rect, { x: 6.75, y: 1.2, w: 6.3, h: 5.9, fill: { color: WHITE }, line: { color: "CCDDEE" } });

  s.addText("Intraoperative Cholangiography (IOC)", { x: 0.35, y: 1.25, w: 6.0, h: 0.45, fontSize: 15, bold: true, color: DEEP_NAVY, fontFace: "Calibri" });
  const iocBullets = [
    "Role in BDI prevention remains controversial",
    "Minority of surgeons use routinely",
    "Most recent population data: IOC does NOT reduce BDI rate",
    { text: "BUT: IOC facilitates EARLY RECOGNITION when injury occurs → reduces morbidity", bold: true, color: TEAL },
    "Selective use recommended (difficult anatomy, suspected CBD stones, anomalies)",
    { text: "MRCP / Fluorescence cholangiography (ICG): emerging alternatives", bold: true, color: MED_BLUE },
    "Near-infrared fluorescence with ICG — growing evidence for real-time biliary anatomy",
  ];
  addBullets(s, iocBullets, 0.35, 1.75, 6.0, 5.3, { fontSize: 13, color: "1A1A2E" });

  s.addText("Subtotal Cholecystectomy (Bailout)", { x: 6.85, y: 1.25, w: 6.0, h: 0.45, fontSize: 15, bold: true, color: DEEP_NAVY, fontFace: "Calibri" });
  const stcBullets = [
    { text: "Fenestrating (open / reconstituting) technique:", bold: true, color: MED_BLUE },
    "Used when CVS unachievable due to severe inflammation",
    "Avoids blind dissection near CBD",
    "Leave posterior gallbladder wall on liver bed",
    "Drain cystic duct stump or pack open",
    { text: "Reconstituting subtotal cholecystectomy:", bold: true, color: MED_BLUE },
    "Divide gallbladder neck, oversew stump, evacuate stones",
    { text: "Both approaches have LOW BDI rates compared to forced dissection", bold: true, color: TEAL },
    { text: "Meta-analysis 2024 (PMID 37739875): no significant difference between fenestrating vs reconstituting for major outcomes", bold: false, color: MED_BLUE },
  ];
  addBullets(s, stcBullets, 6.85, 1.75, 6.1, 5.3, { fontSize: 13, color: "1A1A2E" });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — CLINICAL PRESENTATION & DIAGNOSIS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Clinical Presentation & Diagnosis", "Recognition: intraoperative vs. postoperative");

  // Two-column layout
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.2, w: 6.2, h: 5.9, fill: { color: WHITE }, line: { color: "CCDDEE" } });
  s.addShape(pres.ShapeType.rect, { x: 6.75, y: 1.2, w: 6.3, h: 5.9, fill: { color: WHITE }, line: { color: "CCDDEE" } });

  s.addText("Intraoperative Recognition", { x: 0.35, y: 1.25, w: 6.0, h: 0.4, fontSize: 15, bold: true, color: RED_ALERT, fontFace: "Calibri" });
  const intraBullets = [
    { text: "RARE — <30% identified at time of injury", bold: true, color: RED_ALERT },
    "Confirmation bias is a major barrier to intraop recognition",
    { text: "Clues during surgery:", bold: true },
    { text: "Unexpected bile leak / bilious fluid", sub: true },
    { text: "Two structures clipped/divided (double-structure sign)", sub: true },
    { text: "IOC shows injury or unexpected anatomy", sub: true },
    { text: "If suspected intraoperatively:", bold: true, color: MED_BLUE },
    { text: "Convert to open (if not already)", sub: true },
    { text: "Perform on-table cholangiogram", sub: true },
    { text: "Call hepatobiliary surgeon immediately", sub: true, color: RED_ALERT, bold: true },
    { text: "Do NOT attempt repair without expertise", sub: true, color: RED_ALERT, bold: true },
  ];
  addBullets(s, intraBullets, 0.35, 1.7, 6.0, 5.3, { fontSize: 13, color: "1A1A2E" });

  s.addText("Postoperative Presentation", { x: 6.85, y: 1.25, w: 6.0, h: 0.4, fontSize: 15, bold: true, color: MED_BLUE, fontFace: "Calibri" });
  const postBullets = [
    { text: "Bile leak pattern (early — days to 1 week):", bold: true },
    { text: "Fever, increasing abdominal pain, nausea", sub: true },
    { text: "Jaundice (if bile flows into peritoneum)", sub: true },
    { text: "Wound/drain bile drainage", sub: true },
    { text: "Biloma → peritonitis → sepsis (if unrecognized)", sub: true },
    { text: "Stricture pattern (weeks to months):", bold: true, color: MED_BLUE },
    { text: "<10% strictures identified in first week", sub: true },
    { text: ">70% diagnosed within 6 months", sub: true },
    { text: "Progressive jaundice ± cholangitis", sub: true },
    { text: "Abnormal LFTs: elevated bili, ALP, GGT", sub: true },
    { text: "RUQ pain, fever, chills (Charcot's triad if obstructed)", sub: true },
  ];
  addBullets(s, postBullets, 6.85, 1.7, 6.1, 5.3, { fontSize: 13, color: "1A1A2E" });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — INVESTIGATIONS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Investigations", "Systematic workup to define anatomy before any repair");

  if (images[2] && images[2].base64) {
    s.addImage({ data: images[2].base64, x: 7.8, y: 1.2, w: 5.2, h: 4.0 });
    s.addText("ERCP / MRCP / PTC — multi-modality BDI imaging (Strasberg A, E2, E3)", { x: 7.8, y: 5.2, w: 5.2, h: 0.35, fontSize: 9, color: MED_BLUE, italic: true, align: "center" });
  }

  const investigations = [
    { title: "Laboratory", items: ["Serum bilirubin (direct & total)", "Alkaline phosphatase, GGT, ALT, AST", "CBC, CRP — infection markers", "Coagulation profile (if septic)"] },
    { title: "Ultrasound (initial)", items: ["Biloma / fluid collection", "Biliary dilatation", "Assess liver parenchyma"] },
    { title: "CT Abdomen", items: ["Biloma localization", "Associated vascular injury", "Liver ischemia assessment", "Abscess / peritonitis"] },
    { title: "MRCP (gold standard anatomy)", items: ["Non-invasive biliary map", "Defines level of injury", "Detects stricture vs transection", "Replaced diagnostic ERCP"] },
    { title: "ERCP (diagnostic + therapeutic)", items: ["Identify leak site", "Stent placement (Type A, D)", "Sphincterotomy for low-grade leaks"] },
    { title: "PTC (Percutaneous Transhepatic)", items: ["When ERCP fails / high injury", "Drains obstructed system", "Places transhepatic stents for repair guidance"] },
  ];
  const cols = 2;
  investigations.forEach((inv, i) => {
    const col = i % cols;
    const row = Math.floor(i / cols);
    const x = 0.25 + col * 3.8;
    const y = 1.25 + row * 2.0;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 3.6, h: 1.85, fill: { color: WHITE }, line: { color: "CCDDEE", width: 1 }, rectRadius: 0.07 });
    s.addShape(pres.ShapeType.rect, { x, y, w: 3.6, h: 0.38, fill: { color: MED_BLUE }, line: { color: MED_BLUE } });
    s.addText(inv.title, { x: x + 0.1, y: y + 0.05, w: 3.4, h: 0.3, fontSize: 12, bold: true, color: WHITE, fontFace: "Calibri", valign: "middle" });
    inv.items.forEach((item, j) => {
      s.addText("• " + item, { x: x + 0.1, y: y + 0.42 + j * 0.35, w: 3.4, h: 0.33, fontSize: 11, color: DEEP_NAVY, fontFace: "Calibri" });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — MANAGEMENT PRINCIPLES & GOALS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Management Principles", "Goals of therapy — Sabiston Box 88.1 framework");

  // Goals boxes
  const goals = [
    { icon: "①", title: "Control Sepsis", desc: "Drain biloma, treat cholangitis, stabilize patient FIRST" },
    { icon: "②", title: "Define Anatomy", desc: "Complete biliary mapping before any repair (MRCP, PTC, ERCP)" },
    { icon: "③", title: "Tension-free Repair", desc: "All anastomoses must be tension-free with good blood supply" },
    { icon: "④", title: "Expert Surgeon", desc: "Repair by experienced HPB surgeon — reduces need for re-do surgery" },
    { icon: "⑤", title: "Timing", desc: "Delayed repair (>6 weeks) preferred over early repair (SAGES 2025)" },
    { icon: "⑥", title: "Long-term Follow-up", desc: "Annual LFTs; cholangiography if symptomatic; 5-yr surveillance" },
  ];

  goals.forEach((g, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.25 + col * 4.35;
    const y = 1.2 + row * 3.1;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 4.1, h: 2.9, fill: { color: WHITE }, line: { color: ACCENT_GOLD, width: 2 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.ellipse, { x: x + 1.55, y: y + 0.2, w: 1.0, h: 1.0, fill: { color: MED_BLUE }, line: { color: MED_BLUE } });
    s.addText(g.icon, { x: x + 1.55, y: y + 0.25, w: 1.0, h: 0.9, fontSize: 22, bold: true, color: ACCENT_GOLD, align: "center", valign: "middle" });
    s.addText(g.title, { x: x + 0.1, y: y + 1.3, w: 3.9, h: 0.5, fontSize: 15, bold: true, color: DEEP_NAVY, fontFace: "Calibri", align: "center" });
    s.addText(g.desc, { x: x + 0.1, y: y + 1.85, w: 3.9, h: 0.9, fontSize: 12, color: MED_BLUE, fontFace: "Calibri", align: "center", valign: "top" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — TIMING OF REPAIR (SAGES 2025)
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Timing of Repair — SAGES-AHPBA 2025 Guideline", "Evidence-based recommendations — Surg Endosc 2026 (PMID 41266841)");

  // Guideline box
  s.addShape(pres.ShapeType.roundRect, { x: 0.25, y: 1.2, w: 12.8, h: 1.4, fill: { color: DEEP_NAVY }, line: { color: ACCENT_GOLD, width: 2 }, rectRadius: 0.1 });
  s.addText("SAGES-AHPBA 2025 GUIDELINE — Key Recommendations (GRADE Methodology, Dec 2024 literature)", {
    x: 0.4, y: 1.25, w: 12.5, h: 0.4, fontSize: 14, bold: true, color: ACCENT_GOLD, fontFace: "Calibri"
  });

  const recs = [
    { q: "Timing", rec: "DELAYED (>6 weeks) vs Early (<6 weeks)", strength: "Conditional", evidence: "Low", detail: "Early repair: OR 3.31↑ reoperation, OR 7.41↑ stricture, OR 2.83↑ mortality (meta-analysis)" },
    { q: "Approach", rec: "MIS or Open repair equally acceptable", strength: "Conditional", evidence: "Very Low", detail: "No significant difference in outcomes; surgeon expertise and patient factors guide choice" },
    { q: "Op vs Non-op", rec: "Operative management preferred for major BDI", strength: "Conditional", evidence: "Very Low", detail: "Non-op: OR 16.60↑ reoperation, OR 2.44↑ stricture vs operative management" },
    { q: "Anastomosis", rec: "Hepaticojejunostomy or Hepaticoduodenostomy both acceptable", strength: "Conditional", evidence: "Very Low", detail: "No significant difference in stricture or reintervention rates between the two approaches" },
  ];

  recs.forEach((r, i) => {
    const y = 2.7 + i * 1.15;
    const bgCol = i % 2 === 0 ? WHITE : "F0F4FA";
    s.addShape(pres.ShapeType.roundRect, { x: 0.25, y, w: 12.8, h: 1.05, fill: { color: bgCol }, line: { color: "CCDDEE", width: 1 }, rectRadius: 0.06 });
    s.addShape(pres.ShapeType.rect, { x: 0.25, y, w: 1.5, h: 1.05, fill: { color: MED_BLUE }, line: { color: MED_BLUE } });
    s.addText(r.q, { x: 0.3, y: y + 0.25, w: 1.4, h: 0.55, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", align: "center" });
    s.addText("Recommendation: " + r.rec, { x: 1.85, y: y + 0.05, w: 5.5, h: 0.45, fontSize: 13, bold: true, color: DEEP_NAVY, fontFace: "Calibri" });
    s.addText(r.detail, { x: 1.85, y: y + 0.55, w: 7.0, h: 0.45, fontSize: 11, color: MED_BLUE, fontFace: "Calibri" });
    s.addShape(pres.ShapeType.roundRect, { x: 9.0, y: y + 0.1, w: 1.9, h: 0.4, fill: { color: ACCENT_GOLD }, line: { color: ACCENT_GOLD }, rectRadius: 0.04 });
    s.addText(r.strength, { x: 9.0, y: y + 0.1, w: 1.9, h: 0.4, fontSize: 10, bold: true, color: WHITE, align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.roundRect, { x: 11.05, y: y + 0.1, w: 2.0, h: 0.4, fill: { color: r.evidence === "Low" ? RED_ALERT : "888888" }, line: { color: "666" }, rectRadius: 0.04 });
    s.addText("Evidence: " + r.evidence, { x: 11.05, y: y + 0.1, w: 2.0, h: 0.4, fontSize: 10, bold: true, color: WHITE, align: "center", valign: "middle" });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — SURGICAL REPAIR TECHNIQUES (with image)
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Surgical Repair Techniques", "Based on injury type, level, and tissue quality");

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.2, w: 7.2, h: 5.9, fill: { color: WHITE }, line: { color: "CCDDEE" } });

  const repairBullets = [
    { text: "INTRAOPERATIVE RECOGNITION:", bold: true, color: RED_ALERT },
    { text: "Convert to open; perform on-table cholangiogram", sub: true },
    { text: "Call HPB specialist — resist urge to repair without expertise", sub: true, bold: true, color: RED_ALERT },
    { text: "Partial (Lateral) Injury (Type D):", bold: true, color: MED_BLUE },
    { text: "Primary repair over T-tube with 5-0 absorbable suture + external drain", sub: true },
    { text: "Remove clip; repair small choledochotomy; drain externally", sub: true },
    { text: "Short Segment Transection (<1 cm):", bold: true, color: MED_BLUE },
    { text: "End-to-end anastomosis (4-0 or 5-0 absorbable) + T-tube through separate choledochotomy", sub: true },
    { text: "Kocher maneuver to reduce tension", sub: true },
    { text: "HIGH stricture risk long-term — requires endoscopic surveillance", sub: true, color: RED_ALERT },
    { text: "Proximal / Long-Segment Injury (>1 cm, E2–E5 — PREFERRED):", bold: true, color: MED_BLUE },
    { text: "Roux-en-Y Hepaticojejunostomy (60–70 cm Roux limb)", sub: true, bold: true },
    { text: "Distal duct oversewn; proximal duct debrided; tension-free end-to-side anastomosis", sub: true },
    { text: "Transanastomotic Silastic stents (12–22F) externalized through liver", sub: true },
    { text: "Interrupted 4-0 or 5-0 absorbable sutures; closed suction drain posteriorly", sub: true },
    { text: "Hepaticoduodenostomy: comparable outcomes (SAGES 2025) — but risk of bile reflux", sub: true },
    { text: "High Hilar Injuries (E4, E5):", bold: true, color: RED_ALERT },
    { text: "Separate anastomosis to R and L hepatic ducts over individual stents", sub: true },
    { text: "Requires expert HPB center — best outcomes at high-volume centers", sub: true, bold: true, color: RED_ALERT },
  ];
  addBullets(s, repairBullets, 0.35, 1.25, 7.0, 5.8, { fontSize: 12.5, color: "1A1A2E" });

  if (images[3] && images[3].base64) {
    s.addImage({ data: images[3].base64, x: 7.65, y: 1.2, w: 5.4, h: 5.0 });
    s.addText("MRCP showing E1 BDI + intraoperative hepaticojejunostomy with stent", { x: 7.65, y: 6.2, w: 5.4, h: 0.35, fontSize: 9, color: MED_BLUE, italic: true, align: "center" });
  } else {
    s.addShape(pres.ShapeType.rect, { x: 7.65, y: 1.2, w: 5.4, h: 5.9, fill: { color: DEEP_NAVY } });
    s.addText("Hepaticojejunostomy\nDiagram", { x: 7.75, y: 3.5, w: 5.2, h: 1, fontSize: 16, color: WHITE, align: "center" });
  }
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — NON-OPERATIVE / ENDOSCOPIC MANAGEMENT
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Non-operative & Endoscopic Management", "Role of ERCP, PTC, and percutaneous drainage");

  const sections = [
    {
      title: "Type A (Cystic Duct Leak / Duct of Luschka)",
      color: TEAL,
      items: [
        "First-line: ERCP + sphincterotomy ± biliary stent",
        "Stent bridges pressure gradient — allows cystic stump to seal",
        "Success rate >90% for low-grade leaks",
        "Stent removed after 6–8 weeks; repeat ERCP confirms healing",
      ]
    },
    {
      title: "Type D (Lateral Main Duct Injury without complete transection)",
      color: MED_BLUE,
      items: [
        "ERCP + stenting: effective for partial injuries",
        "If stricture develops postoperatively: endoscopic dilation + stenting",
        "Excellent long-term outcomes with serial dilation protocols",
      ]
    },
    {
      title: "Biloma / Bile Peritonitis",
      color: ACCENT_GOLD,
      items: [
        "Percutaneous drainage (IR-guided) of collections",
        "External biliary drainage if bile peritonitis / sepsis",
        "Nutritional support during biliary diversion period",
        "Replace bile salts / electrolytes (complete biliary diversion)",
      ]
    },
    {
      title: "Established Strictures (Post-repair)",
      color: RED_ALERT,
      items: [
        "PTC: balloon dilation ± plastic stents (multiple sessions)",
        "SEMS (fully covered) for refractory benign strictures — growing evidence",
        "Endoscopic approach for stenosed hepaticojejunostomies (via balloon-assisted enteroscopy)",
        "Liver transplantation: last resort for failed reconstructions (PMID 37633743)",
      ]
    },
  ];

  sections.forEach((sec, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.25 + col * 6.55;
    const y = 1.2 + row * 3.1;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 6.3, h: 2.9, fill: { color: WHITE }, line: { color: sec.color, width: 2 }, rectRadius: 0.08 });
    s.addShape(pres.ShapeType.rect, { x, y, w: 6.3, h: 0.4, fill: { color: sec.color }, line: { color: sec.color } });
    s.addText(sec.title, { x: x + 0.1, y: y + 0.05, w: 6.1, h: 0.32, fontSize: 12.5, bold: true, color: WHITE, fontFace: "Calibri", valign: "middle" });
    sec.items.forEach((item, j) => {
      s.addText("• " + item, { x: x + 0.15, y: y + 0.48 + j * 0.55, w: 6.0, h: 0.5, fontSize: 12, color: DEEP_NAVY, fontFace: "Calibri" });
    });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 — VASCULOBILIARY INJURIES
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Vasculobiliary Injuries", "A distinct and high-risk category");

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.2, w: 12.8, h: 5.9, fill: { color: WHITE }, line: { color: "CCDDEE" } });

  calloutBox(s, "Vasculobiliary injury: Simultaneous bile duct + hepatic artery / portal vein injury — significantly worsens prognosis", 0.35, 1.28, 12.5, 0.55, RED_ALERT);

  const vbiBullets = [
    { text: "Most common: right hepatic artery injury (stricture or occlusion) concurrent with BDI", bold: true },
    "Portal vein injuries less common but reported",
    { text: "Mechanism: excessive dissection medial to CBD, aggressive bleeding control", bold: false },
    { text: "Why it matters:", bold: true, color: RED_ALERT },
    { text: "Biliary blood supply compromised → ischemic stricture even after perfect repair", sub: true },
    { text: "Substantially increases stricture formation rate post-hepaticojejunostomy", sub: true },
    { text: "Increases liver failure risk, especially right lobe atrophy", sub: true },
    { text: "Diagnosis:", bold: true, color: MED_BLUE },
    { text: "CT angiography / MR angiography + MRCP — essential before repair", sub: true },
    { text: "Doppler ultrasound: assess hepatic artery flow", sub: true },
    { text: "Management:", bold: true, color: MED_BLUE },
    { text: "Vascular repair / reconstruction concurrent with biliary repair when possible", sub: true },
    { text: "Refer to high-volume HPB center with vascular surgery availability", sub: true, bold: true, color: RED_ALERT },
    { text: "Liver transplantation may be required in cases of liver failure (systematic review PMID 37633743)", sub: true },
  ];
  addBullets(s, vbiBullets, 0.35, 1.92, 12.5, 5.1, { fontSize: 14, color: "1A1A2E" });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 — OUTCOMES
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Outcomes & Long-term Follow-up", "Results after repair and predictors of success");

  // Outcome stat boxes row
  const outcomeStats = [
    { val: "70–90%", label: "5-yr success\nhepaticojejunostomy", color: TEAL },
    { val: "20–30%", label: "Long-term\nstricture rate", color: ACCENT_GOLD },
    { val: "↑3.3x", label: "Reoperation risk\nearly vs late repair", color: RED_ALERT },
    { val: "↑7.4x", label: "Stricture risk\nearly vs late repair", color: RED_ALERT },
  ];
  outcomeStats.forEach((o, i) => {
    const x = 0.25 + i * 3.2;
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.2, w: 3.0, h: 1.6, fill: { color: o.color }, line: { color: WHITE, width: 1 }, rectRadius: 0.1 });
    s.addText(o.val, { x: x + 0.1, y: 1.22, w: 2.8, h: 0.85, fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(o.label, { x: x + 0.1, y: 2.05, w: 2.8, h: 0.65, fontSize: 11.5, color: WHITE, fontFace: "Calibri", align: "center" });
  });

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 3.0, w: 12.8, h: 4.1, fill: { color: WHITE }, line: { color: "CCDDEE" } });
  const outcomeBullets = [
    { text: "Predictor of success: repair by HPB specialist, delayed repair, tension-free anastomosis, adequate stenting", bold: true, color: TEAL },
    "Bismuth E3–E5 injuries have lower success rates and higher complication rates than E1–E2",
    { text: "Re-stricture rate: 10–30% within 5 years; most amenable to re-dilation or re-do hepaticojejunostomy", bold: false },
    { text: "Quality of life: significantly impaired post-BDI — comparable to other major abdominal morbidities", bold: false, color: RED_ALERT },
    "Mortality from BDI: 0.2–0.8% directly; higher with vasculobiliary injury",
    { text: "Long-term follow-up protocol: Annual LFTs (bilirubin, ALP, GGT) for life; cholangiography if LFTs abnormal", bold: true, color: MED_BLUE },
    "Cholangitis episodes: treated with antibiotics + endoscopic/percutaneous re-intervention",
    { text: "Liver transplantation outcomes: acceptable (systematic review 2023, PMID 37633743) — but high morbidity", bold: false, color: RED_ALERT },
  ];
  addBullets(s, outcomeBullets, 0.35, 3.05, 12.5, 4.0, { fontSize: 14, color: "1A1A2E" });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 17 — MEDICOLEGAL CONSIDERATIONS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Medicolegal Considerations", "BDI is a leading cause of surgical malpractice claims");

  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.2, w: 12.8, h: 5.9, fill: { color: WHITE }, line: { color: "CCDDEE" } });

  calloutBox(s, "BDI is ONE of the most common reasons for surgical malpractice litigation — informed consent, documentation, and early disclosure are critical", 0.35, 1.28, 12.5, 0.55, RED_ALERT);

  const legalBullets = [
    { text: "Informed consent:", bold: true, color: MED_BLUE },
    { text: "Patient must be counseled about BDI risk (<1%) BEFORE cholecystectomy", sub: true },
    { text: "Document discussion of bile leak, stricture, conversion to open", sub: true },
    { text: "Intraoperative documentation:", bold: true, color: MED_BLUE },
    { text: "Always photograph/document CVS achievement before clipping", sub: true, bold: true },
    { text: "Document IOC findings if performed", sub: true },
    { text: "Document any conversion decision and rationale", sub: true },
    { text: "When BDI occurs:", bold: true, color: RED_ALERT },
    { text: "Transparent, prompt disclosure to patient and family", sub: true, bold: true },
    { text: "Immediate referral to experienced HPB surgeon (critical for outcome AND medicolegal protection)", sub: true },
    { text: "Incident reporting through institutional channels", sub: true },
    { text: "Do NOT attempt complex repair without HPB expertise — worsens outcome AND liability", sub: true, bold: true, color: RED_ALERT },
    { text: "Key principle:", bold: true, color: MED_BLUE },
    { text: "It is not the injury itself, but the delay in diagnosis and failed repair, that drive most successful litigation", sub: true, bold: true, color: RED_ALERT },
  ];
  addBullets(s, legalBullets, 0.35, 1.9, 12.5, 5.1, { fontSize: 13.5, color: "1A1A2E" });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 18 — ALGORITHM (flowchart text-based)
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addHeader(s, "Management Algorithm", "Stepwise approach to suspected BDI");

  const steps = [
    { label: "SUSPECTED BDI\n(Intraop or Postop)", color: RED_ALERT, x: 5.0, y: 1.2, w: 3.3 },
    { label: "STABILIZE: Control sepsis\nDrain biloma (IR) / ABx", color: MED_BLUE, x: 0.3, y: 2.3, w: 3.4 },
    { label: "DEFINE ANATOMY:\nMRCP + CT angiography ± PTC", color: MED_BLUE, x: 4.8, y: 2.3, w: 3.7 },
    { label: "REFER TO\nHPB SPECIALIST", color: TEAL, x: 9.7, y: 2.3, w: 3.2 },
    { label: "TYPE A / D Injury\nBile leak / partial", color: ACCENT_GOLD, x: 0.3, y: 4.0, w: 3.0 },
    { label: "TYPE E (complete\ntransection / stricture)", color: RED_ALERT, x: 5.2, y: 4.0, w: 3.0 },
    { label: "Vasculobiliary\nInjury", color: "8B0000", x: 9.9, y: 4.0, w: 3.2 },
    { label: "ERCP + Stent\n(90% success)", color: TEAL, x: 0.3, y: 5.5, w: 2.5 },
    { label: "Delayed repair\n>6 weeks\nRoux-en-Y HJ", color: TEAL, x: 3.5, y: 5.5, w: 3.0 },
    { label: "High-volume\nHPB center\n± Vascular repair", color: MED_BLUE, x: 7.2, y: 5.5, w: 3.0 },
    { label: "Annual LFT surveillance — cholangiography if abnormal", color: DEEP_NAVY, x: 0.3, y: 6.9, w: 12.7 },
  ];

  steps.forEach(st => {
    s.addShape(pres.ShapeType.roundRect, { x: st.x, y: st.y, w: st.w, h: st.h > 0 ? st.h : 0.85, fill: { color: st.color }, line: { color: WHITE, width: 1 }, rectRadius: 0.07 });
    s.addText(st.label, { x: st.x + 0.05, y: st.y + 0.05, w: st.w - 0.1, h: (st.h || 0.85) - 0.1, fontSize: 11.5, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle" });
  });

  // Arrows (lines)
  const arrowOpts = { line: { color: ACCENT_GOLD, width: 2 }, headEnd: { type: "arrow" } };
  [[6.65, 2.05, 6.65, 2.3], [1.95, 3.15, 1.95, 4.0], [6.65, 3.15, 6.65, 4.0], [11.3, 3.15, 11.3, 4.0],
   [1.75, 4.85, 1.5, 5.5], [6.7, 4.85, 5.0, 5.5], [11.3, 4.85, 8.7, 5.5],
   [4.6, 6.35, 4.6, 6.9]].forEach(([x1, y1, x2, y2]) => {
    s.addShape(pres.ShapeType.line, { x: x1, y: y1, w: Math.abs(x2 - x1) || 0.01, h: Math.abs(y2 - y1) || 0.01, line: { color: ACCENT_GOLD, width: 2 } });
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// SLIDE 19 — KEY TAKEAWAYS
// ═══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  titleSlide(s);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.2, h: 7.5, fill: { color: ACCENT_GOLD } });

  s.addText("KEY TAKEAWAYS", {
    x: 0.5, y: 0.25, w: 12, h: 0.65,
    fontSize: 32, bold: true, color: ACCENT_GOLD, fontFace: "Calibri", charSpacing: 4, margin: 0
  });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.9, w: 10, h: 0.05, fill: { color: ACCENT_GOLD } });

  const takeaways = [
    { num: "1", text: "Misidentification of anatomy (NOT skill) drives most BDIs — confirmation bias is the enemy" },
    { num: "2", text: "Critical View of Safety: the single most effective BDI prevention strategy — document it photographically" },
    { num: "3", text: "When in doubt: subtotal cholecystectomy, cholecystostomy, or IOC — not forced dissection" },
    { num: "4", text: "Strasberg-Bismuth E3–E5 injuries require specialist HPB surgery — do NOT attempt at the index operation without expertise" },
    { num: "5", text: "SAGES-AHPBA 2025: delayed repair (>6 weeks) is superior to early repair — lower stricture, reoperation, mortality" },
    { num: "6", text: "Roux-en-Y hepaticojejunostomy is the gold standard for major BDI reconstruction; hepaticoduodenostomy is an alternative" },
    { num: "7", text: "Always assess for vasculobiliary injury — it dramatically increases stricture risk even after perfect repair" },
    { num: "8", text: "Transparent disclosure + early HPB referral = best medicolegal and clinical protection" },
  ];

  takeaways.forEach((t, i) => {
    const y = 1.05 + i * 0.78;
    s.addShape(pres.ShapeType.ellipse, { x: 0.5, y: y + 0.05, w: 0.5, h: 0.5, fill: { color: ACCENT_GOLD }, line: { color: ACCENT_GOLD } });
    s.addText(t.num, { x: 0.5, y: y + 0.05, w: 0.5, h: 0.5, fontSize: 14, bold: true, color: DEEP_NAVY, align: "center", valign: "middle" });
    s.addText(t.text, { x: 1.15, y: y, w: 11.8, h: 0.68, fontSize: 14.5, color: WHITE, fontFace: "Calibri", valign: "middle" });
  });

  s.addText("Sources: Sabiston Surgery 21e • Current Surgical Therapy 14e • Mulholland & Greenfield 7e • SAGES-AHPBA 2025 Guideline (Surg Endosc 2026)", {
    x: 0.5, y: 6.88, w: 12.6, h: 0.45,
    fontSize: 10, color: "8899BB", fontFace: "Calibri", align: "center", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ═══════════════════════════════════════════════════════════════════════════════
const outputPath = "/home/daytona/workspace/bile-duct-injury-ppt/Iatrogenic_Bile_Duct_Injuries.pptx";
pres.writeFile({ fileName: outputPath })
  .then(() => console.log("SUCCESS: " + outputPath))
  .catch(err => console.error("ERROR:", err));