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

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.

Endoscopic application of magnetic compression anastomosis: a review

“…20,21 For traditional surgical procedures, however, there is a high incidence of postoperative recurrent stenosis or other adverse outcomes, such as bile leakage, postoperative infections, and abscess development. 20,[22][23][24] Nonsurgical techniques, such as endoscopic stenting or balloon dilatation, have shown greater safety and fewer complications in the treatment of benign biliary stenosis. 25,26 However, endoscopic treatment is unsuccessful when the bile duct is completely obstructed or severely narrowed and a guidewire cannot be placed through the endoscope.…”

Outcomes of hepaticojejunostomy for post-cholecystectomy bile duct injury

“…Nevertheless, the best time for repair of BDI is yet to be determined. 36 Therefore, in patients with previous BDI repair, we classified BDI on the basis of the location of the stricture at the time of presentation to our center. The actual injury might have been less complex and distal than what we actually had to deal with.…”

Routine magnetic resonance cholangiopancreatography before laparoscopic cholecystectomy in patients with cholecystolithiasis

“…Better understanding the anatomy of biliary tract and estimating the di culty of LC before operation would be helpful to reduce the occurrence of complications such as bile duct injury. MRCP may prevent the injury of normal and variant bile ducts and reduce the incidence of conversion to open surgery [29][30][31]. In the control group, one patient with common bile duct injury failed to detect the bile duct variation by preoperative abdominal ultrasound, which may be one of the reasons for bile duct injury.…”