Published online Feb 27, 2022. doi: 10.4254/wjh.v14.i2.442
Peer-review started: June 19, 2021
First decision: July 16, 2021
Revised: October 2, 2021
Accepted: February 10, 2022
Article in press: February 10, 2022
Published online: February 27, 2022
Processing time: 247 Days and 20.8 Hours
Bile duct injuries (BDIs) are an important topic for the practicing hepatobiliary (HPB) surgeon. While it is widely agreed that most major BDIs after laparoscopic cholecystectomy (LC) should undergo surgical repair, the timing of repair is still controversially discussed in the literature.
Our research motivation was: (1) To bring clarity into the terms "immediate", "early", "delayed", and "late" repair; and (2) to assess postoperative complications.
The objective of this study was to assess timing of bile duct repair after BDI and postoperative complications.
A systematic review of the literature was performed using the databases MEDLINE, EMBASE, and The Cochrane Library. These databases were systematically screened up to August 2021. Bias assessment was performed using the Newcastle Ottawa scale.
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.
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.
Future perspectives include the establishment of a clear definition for the terms "immediate", "early", "delayed", and "late" repair. Only such a definition can make comparisons of study outcomes possible.