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Review
. 2024 Feb 3;16(2):e53507.
doi: 10.7759/cureus.53507. eCollection 2024 Feb.

Optimal Timing of Surgical Repair After Bile Duct Injury: A Systematic Review and Meta-Analysis

Sri Saran Manivasagam  1 , Nemi Chandra J  2 , Dhananjay Khera  2 , Pramatheshwara S Aradhya  2 , Aashutosh M Hiremath  2
Affiliations
Review

Optimal Timing of Surgical Repair After Bile Duct Injury: A Systematic Review and Meta-Analysis

Sri Saran Manivasagam et al. Cureus. .

Abstract

Background: Major bile duct injury during cholecystectomy often requires surgical reconstruction. The optimal timing of repair is debated.

Objectives: To assess the association between the timing of hepaticojejunostomy and postoperative morbidity, mortality, and anastomotic stricture.

Methods: Systematic review and meta-analysis of observational studies comparing early (<14 days), intermediate (14 days-6 weeks), and late (>6 weeks) repair. Primary outcomes were postoperative morbidity, mortality, and stricture rates. Pooled risk ratios were calculated. A generalized linear model was used to estimate odds per time interval.

Results: 20 studies were included in the systematic review. Of these, data from 15 studies was included in the meta-analyses. The 20 included studies comprised a total of 3421 patients who underwent hepaticojejunostomy for bile duct injury. Early repair was associated with lower morbidity versus intermediate repair (RR 0.73, 95% CI 0.54-0.98). Delayed repair had lower morbidity versus intermediate (RR 1.50, 95% CI 1.16-1.93). Delayed repair had a lower stricture rate versus intermediate repair (RR 1.53, 95% CI 1.07-2.20). Mortality was not associated with timing.

Conclusions: Reconstruction between 2 and 6 weeks after bile duct injury should be avoided given the higher morbidity and stricture rates. Delayed repair after 6 weeks may be beneficial.

Keywords: bile duct injury; hepaticojejunostomy; lap cholecystectomy; surgical repair; timing of repair.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flow diagram
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Forrest plot of morbidity meta-analysis
Figure 3
Figure 3. Generalized linear model of morbidity
Figure 4
Figure 4. Forest plot of mortality meta-analysis
Figure 5
Figure 5. Forest plot of stricture meta-analysis
Figure 6
Figure 6. Generalized linear model of stricture
See this image and copyright information in PMC

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