Meta-Analysis
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World J Gastroenterol. Jan 21, 2014; 20(3): 843-851
Published online Jan 21, 2014. doi: 10.3748/wjg.v20.i3.843
Remains of the day: Biliary complications related to single-port laparoscopic cholecystectomy
Pierre Allemann, Nicolas Demartines, Markus Schäfer
Pierre Allemann, Nicolas Demartines, Markus Schäfer, Department of Visceral Surgery, University Hospital CHUV, CH 1011 Lausanne, Switzerland
Author contributions: Demartines N and Schäfer M designed research; Allemann P and Schäfer M performed research; Allemann P contributed new reagents or analytic tools; Allemann P, Schäfer M analyzed data; Allemann P wrote the draft of the manuscript; Demartines N and Schäfer M made critical corrections and revision
Correspondence to: Nicolas Demartines, MD, FACS, FRCS, Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, CH 1011 Lausanne, Switzerland. demartines@chuv.ch
Telephone: +41-21-3142400 Fax: +41-21-3142311
Received: June 15, 2013
Revised: August 14, 2013
Accepted: August 20, 2013
Published online: January 21, 2014
Processing time: 248 Days and 18.5 Hours
Abstract

AIM: To assesse the rate of bile duct injuries (BDI) and overall biliary complications during single-port laparoscopic cholecystectomy (SPLC) compared to conventional laparoscopic cholecystectomy (CLC).

METHODS: SPLC has recently been proposed as an innovative surgical approach for gallbladder surgery. So far, its safety with respect to bile duct injuries has not been specifically evaluated. A systematic review of the literature published between January 1990 and November 2012 was performed. Randomized controlled trials (RCT) comparing SPLC versus CLC reporting BDI rate and overall biliary complications were included. The quality of RCT was assessed using the Jadad score. Analysis was made by performing a meta-analysis, using Review Manager 5.2. This study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A retrospective study including all retrospective reports on SPLC was also performed alongside.

RESULTS: From 496 publications, 11 RCT including 898 patients were selected for meta-analysis. No studies were rated as high quality (Jadad score ≥ 4). Operative indications included benign gallbladder disease operated in an elective setting in all studies, excluding all emergency cases and acute cholecystitis. The median follow-up was 1 mo (range 0.03-18 mo). The incidence of BDI was 0.4% for SPLC and 0% for CLC; the difference was not statistically different (P = 0.36). The incidence of overall biliary complication was 1.6% for SPLC and 0.5% for CLC, the difference did not reached statistically significance (P = 0.21, 95%CI: 0.66-15). Sixty non-randomized trials including 3599 patients were also analysed. The incidence of BDI reported then was 0.7%.

CONCLUSION: The safety of SPLC cannot be assumed, based on the current evidence. Hence, this new technology cannot be recommended as standard technique for laparoscopic cholecystectomy.

Keywords: Bile ducts; Cholecystectomy; Single port; Single incision

Core tip: This study assessed the rate of Bile Duct Injuries and overall biliary complications during single port laparoscopic cholecystectomy. A systematic review of the literature was performed, including 11 randomized controlled trials (898 patients) and 60 non-randomized trials (3599 patients). No statistically significant differences were found. However, interpretation of the results was impaired by several limitations. Based on a retrospective analysis, an incidence of bile duct injuries up to 0.7% was found. The safety of single-port laparoscopic cholecystectomy cannot be assumed, based on the current evidence. Hence, this new technology cannot be recommended as standard technique for laparoscopic cholecystectomy so far.