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Meta-Analysis
. 2018 May;32(5):2175-2183.
doi: 10.1007/s00464-017-5974-2. Epub 2018 Mar 19.

Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis

Philip H Pucher  1 , L Michael Brunt  2 , Neil Davies  3   4 , Ali Linsk  5 , Amani Munshi  6 , H Alejandro Rodriguez  7 , Abe Fingerhut  8 , Robert D Fanelli  9 , Horacio Asbun  10 , Rajesh Aggarwal  11   12 ; SAGES Safe Cholecystectomy Task Force
Affiliations
Meta-Analysis

Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis

Philip H Pucher et al. Surg Endosc. 2018 May.

Abstract

Background: Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical procedures, remains associated with significant major morbidity including bile leak and bile duct injury (BDI). The effect of changes in practice over time, and of interventions to improve patient safety, on morbidity rates is not well understood. The aim of this review was to describe current incidence rates and trends for BDI and other complications during and after LC, and to identify risk factors and preventative measures associated with morbidity and BDI.

Methods: PubMed, MEDLINE, and Web of Science database searches and data extraction were conducted for studies which reported individual complications and complication rates following laparoscopic cholecystectomy in a representative population. Outcomes data were pooled. Meta-regression analysis was performed to assess factors associated with conversion, morbidity, and BDI rates.

Results: One hundred and fifty-one studies reporting outcomes for 505,292 patients were included in the final quantitative synthesis. Overall morbidity, BDI, and mortality rates were 1.6-5.3%, 0.32-0.52%, and 0.08-0.14%, respectively. Reported BDI rates reduced over time (1994-1999: 0.69(0.52-0.84)% versus 2010-2015 0.22(0.02-0.40)%, p = 0.011). Meta-regression analysis suggested higher conversion rates in developed versus developing countries (4.7 vs. 3.4%), though a greater degree of reporting bias was present in these studies, with no other significant associations identified.

Conclusions: Overall, trends suggest a reduction in BDI over time with unchanged morbidity and mortality rates. However, data and reporting are heterogenous. Establishment of international outcomes registries should be considered.

Keywords: Bile duct injury; Bile leak; Cholecystectomy; Laparoscopy; Open; Outcomes.

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Conflict of interest statement

The authors have received no funding and declare no conflicts of interest in relation to this specific work. Dr. Aggarwal is a consultant for Applied Medical. Dr. Davies is affiliated with the MRC Integrative Epidemiology Unit [MC_UU_12013/9], which receives funding from the Medical Research Council (MRC) and the University of Bristol. Dr. Fanelli declares the following relationships: Consultant in device development, Cook Incorporated; Consultant, Boston Scientific Corporation, Inc.; Ownership interest, Allurion Technologies, Inc.; Ownership interest, Mozaic Medical, Inc.; Ownership interest, Innerspace Surgical Corporation, Inc.; Ownership interest, Respiratory Motion, Inc. Drs. Pucher, Brunt, Linsk, Munshi, Rodriguez, Fingerhut, and Asbun have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Literature search flow diagram
Fig. 2
Fig. 2
Boxplots for A bile duct injury rates, B morbidity rates, and C conversion rates, for each 5-year interval of included data
Fig. 3
Fig. 3
Funnel plot for bile duct injury rates
Fig. 4
Fig. 4
Comparison of funnel plots for conversion rates for developing (left) and developed (right) countries
See this image and copyright information in PMC

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References

    1. Shaffer EA. Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20:981–996. doi: 10.1016/j.bpg.2006.05.004. - DOI - PubMed
    1. Club SS. A prospective analysis of 1518 laparoscopic cholecystectomies. The Southern Surgeons Club. N Engl J Med. 1991;324:1073–1078. doi: 10.1056/NEJM199104183241601. - DOI - PubMed
    1. Harboe KM, Bardram L. The quality of cholecystectomy in Denmark: outcome and risk factors for 20,307 patients from the national database. Surg Endosc. 2011;25:1630–1641. doi: 10.1007/s00464-010-1453-8. - DOI - PubMed
    1. Waage A, Nilsson M. Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish inpatient registry. Arch Surg. 2006;141:1207–1213. doi: 10.1001/archsurg.141.12.1207. - DOI - PubMed
    1. Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T. Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA. 2003;289:1639–1644. doi: 10.1001/jama.289.13.1639. - DOI - PubMed

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