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 laparoscopiccholecystectomy (LC) is challenging and the optimal timing of surgery remainsunclear. The primary aim of this study was to systematically evaluate theevidence behind the timing of BDI repair after LC in the literature.AIMTo assess timing of surgical repair of BDI and postoperative complications.METHODSThe MEDLINE, EMBASE, and The Cochrane Library databases were systematicallyscreened up to August 2021. Risk of bias was assessed via the NewcastleOttawa scale. The primary outcomes of this review included the timing of BDIrepair and postoperative complications.RESULTSA total of 439 abstracts were screened, and 24 studies were included with 15609patients included in this review. Of the 5229 BDIs reported, 4934 (94%) wereclassified 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 amongstudies. 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) andlate repair (> 6 wk after LC) showed a broad overlap.CONCLUSIONThe lack of standardization among studies precludes any conclusive recommendation on optimaltiming of BDI repair after LC. This finding indicates an urgent need for a standardized reportingsystem of BDI repair