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. 2022 Feb 27;14(2):442-455.
doi: 10.4254/wjh.v14.i2.442.

Timing of surgical repair of bile duct injuries after laparoscopic cholecystectomy: A systematic review

Patryk Kambakamba  1 , Sinead Cremen  1 , Beat Möckli  2 , Michael Linecker  3
Affiliations

Timing of surgical repair of bile duct injuries after laparoscopic cholecystectomy: A systematic review

Patryk Kambakamba et al. World J Hepatol. .

Abstract

Background: The surgical management of bile duct injuries (BDIs) after laparoscopic cholecystectomy (LC) is challenging and the optimal timing of surgery remains unclear. The primary aim of this study was to systematically evaluate the evidence behind the timing of BDI repair after LC in the literature.

Aim: To assess timing of surgical repair of BDI and postoperative complications.

Methods: The MEDLINE, EMBASE, and The Cochrane Library databases were systematically screened up to August 2021. Risk of bias was assessed via the Newcastle Ottawa scale. The primary outcomes of this review included the timing of BDI repair and postoperative complications.

Results: A total of 439 abstracts were screened, and 24 studies were included with 15609 patients included in this review. Of the 5229 BDIs reported, 4934 (94%) were classified as major injury. Timing of bile duct repair was immediate (14%, n = 705), early (28%, n = 1367), delayed (28%, n = 1367), or late (26%, n = 1286). Standardization of definition for timing of repair was remarkably poor among studies. Definitions for immediate repair ranged from < 24 h to 6 wk after LC while early repair ranged from < 24 h to 12 wk. Likewise, delayed (> 24 h to > 12 wk after LC) and late repair (> 6 wk after LC) showed a broad overlap.

Conclusion: The lack of standardization among studies precludes any conclusive recommendation on optimal timing of BDI repair after LC. This finding indicates an urgent need for a standardized reporting system of BDI repair.

Keywords: Bile duct injury; Biliary reconstruction; Delayed repair; Early repair; Immediate repair; Laparoscopic cholecystectomy; Late repair; Major bile duct injury; Standardization of bile duct injury repair reporting; Surgical repair.

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Conflict of interest statement

Conflict-of-interest statement: All the authors declare no conflict of interest for this article.

Figures

Figure 1
Figure 1
Flowchart of literature research.
Figure 2
Figure 2
Recommendation of bile duct injury repair. Eleven studies postulated recommendations for optimal timing of bile duct injury repair.
Figure 3
Figure 3
Distribution of definitions of bile duct injury repair timing. Definitions of timing were heterogeneous among publications. Immediate, early, delayed, and late repairs were defined in four, five, six, and five different manners.
Figure 4
Figure 4
Overlapping definitions of timing of bile duct injury repair. A: Dotted lines indicate different cut offs according to heterogeneous definitions of timing; B: Subgroup analysis after exclusion of overlapping definitions. Dotted lines indicates cut off for BDI repair at 14 d after LC. 1: 24 h and 72 h. 61: 45 d.
See this image and copyright information in PMC

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