Systematic review of cystic duct closure techniques in relation to prevention of bile duct leakage after laparoscopic cholecystectomy

doi:10.4240/wjgs.v10.i6.57

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World Journal of Gastrointestinal Surgery. Sep 27, 2018; 10(6): 57-69
Published online Sep 27, 2018. doi: 10.4240/wjgs.v10.i6.57

Systematic review of cystic duct closure techniques in relation to prevention of bile duct leakage after laparoscopic cholecystectomy

Aafke H van Dijk, Stijn van Roessel, Philip R de Reuver, Djamila Boerma, Marja A Boermeester, Sandra C Donkervoort

Aafke H van Dijk, Stijn van Roessel, Marja A Boermeester, Departement of Surgery, Amsterdam University Medical Centre, Amsterdam 1105 AZ, The Netherlands

Philip R de Reuver, Department of Surgery, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands

Djamila Boerma, Department of Surgery, St. Antonius Hospital, Nieuwegein 3435 CM, The Netherlands

Sandra C Donkervoort, Department of Surgery, Onze Lieve Vrouw Gasthuis, Amsterdam 1091 AC, The Netherlands

Author contributions: van Dijk AH, Donkervoort SC, Boerma D, Boermeester MA and de Reuver PR conceptualized and designed the review together; van Dijk AH and van Roessel S carried out analysis; van Dijk AH, van Roessel S and de Reuver PR drafted the manuscript; all authors reviewed and approved the final manuscript as submitted.

Conflict-of-interest statement: No conflicts of interests or disclosures.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Correspondence to: Aafke H van Dijk, MD, Research Fellow, Departement of Surgery, Amsterdam University Medical Centre, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands. a.h.vandijk@amc.uva.nl

Telephone: +31-20-5662766

Received: August 2, 2018
Peer-review started: August 3, 2018
First decision: August 8, 2018
Revised: August 18, 2018
Accepted: August 28, 2018
Article in press: August 28, 2018
Published online: September 27, 2018
Processing time: 54 Days and 0.4 Hours

Abstract

AIM

To study the effect of different techniques of cystic duct closure on bile leakage after laparoscopic cholecystectomy (LC) for biliary disease.

METHODS

A systematic search of MEDLINE, Cochrane and EMBASE was performed. Rate of cystic duct leakage (CDL) was the primary outcome. Risk of bias was evaluated. Odds ratios were analyzed for comparison of techniques and pooled event rates for non-comparative analyses. Pooled event rates were compared for each of included techniques.

RESULTS

Out of 1491 articles, 38 studies were included. A total of 47491 patients were included, of which 38683 (81.5%) underwent cystic duct closure with non-locking (metal) clips. All studies were of low-moderate methodological quality. Only two studies reported separate data on uncomplicated and complicated gallbladder disease. For overall CDL, an odds ratio of 0.4 (95%CI: 0.06-2.48) was found for harmonic energy vs clip closure and an odds ratio of 0.17 (95%CI: 0.03-0.93) for locking vs non-locking clips. Pooled CDL rate was around 1% for harmonic energy and metal clips, and 0% for locking clips and ligatures.

CONCLUSION

Based on available evidence it is not possible to either recommend or discourage any of the techniques for cystic duct closure during LC with respects to CDL, although data point out a slight preference for locking clips and ligatures vs other techniques. No separate recommendation can be made for complicated gallbladder disease.

Keywords: Biliary surgery; Cholecystectomy; Outcomes; Cystic duct leakage; Prevention

Core tip: Cystic duct leakage (CDL) is an unwanted, potential life threatening complication of laparoscopic cholecystectomy (LC). Several techniques have been described to securely close the cystic duct during cholecystectomy. Based on available evidence from this systematic review, it is not possible to either recommend or discourage any of the techniques for cystic duct closure during LC with respect to CDL, although data point out a slight preference for locking clips and ligatures vs other techniques. No separate recommendation can be made for complicated gallbladder disease.