Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis

Abstract

BackgroundLaparoscopic cholecystectomy (LC), one of the most commonly performed surgical procedures, remains associated with significant major morbidity including bile leak and bile duct injury (BDI). The effect of changes in practice over time, and of interventions to improve patient safety, on morbidity rates is not well understood. The aim of this review was to describe current incidence rates and trends for BDI and other complications during and after LC, and to identify risk factors and preventative measures associated with morbidity and BDI.MethodsPubMed, MEDLINE, and Web of Science database searches and data extraction were conducted for studies which reported individual complications and complication rates following laparoscopic cholecystectomy in a representative population. Outcomes data were pooled. Meta-regression analysis was performed to assess factors associated with conversion, morbidity, and BDI rates.ResultsOne hundred and fifty-one studies reporting outcomes for 505,292 patients were included in the final quantitative synthesis. Overall morbidity, BDI, and mortality rates were 1.6–5.3%, 0.32–0.52%, and 0.08–0.14%, respectively. Reported BDI rates reduced over time (1994–1999: 0.69(0.52–0.84)% versus 2010–2015 0.22(0.02–0.40)%, p = 0.011). Meta-regression analysis suggested higher conversion rates in developed versus developing countries (4.7 vs. 3.4%), though a greater degree of reporting bias was present in these studies, with no other significant associations identified.ConclusionsOverall, trends suggest a reduction in BDI over time with unchanged morbidity and mortality rates. However, data and reporting are heterogenous. Establishment of international outcomes registries should be considered.Electronic supplementary materialThe online version of this article (10.1007/s00464-017-5974-2) contains supplementary material, which is available to authorized users.

Initial single institution experience with robotic biliary surgery and bilio‐enteric anastomosis in southeast Asia

“…13,14 However, its use is mainly limited to relatively straightforward conditions such as biliary colic, symptomatic gallstones and early acute cholecystitis. 13,14 However, its use is mainly limited to relatively straightforward conditions such as biliary colic, symptomatic gallstones and early acute cholecystitis.…”

“…Laparoscopic cholecystectomy remains the most common minimally invasive biliary surgery performed worldwide today and it is now regarded as the gold standard approach of choice. 13,14 However, its use is mainly limited to relatively straightforward conditions such as biliary colic, symptomatic gallstones and early acute cholecystitis. 13,14 When applied to more complicated conditions such as perforated/gangrenous cholecystitis, 15 choledocholithiasis 16 and Mirizzi syndrome, 17,18 the laparoscopic approach has been reported to be associated with high open conversion rates of up to 70%.…”

Modified Longmire procedure: a novel approach to bile duct injury repair

“…A systematic review of 151 studies showed that rates of bile duct injury (BDI) have been reduced over time (1994-1999: 0.69% (0.52-0.84%) versus 2010-2015: 0.22% (0.02-0.40%), P = 0.011). 3 However, a recent database review study of BDI showed that less experienced surgeons reported BDI rates three times higher than their more experienced counterparts. 4 Additionally, a European-based population study showed that high volume centres (defined as >244 LC/year) reported lower morbidity, mortality and reoperation rates, 5 suggesting a relationship between case volume and BDI frequency.…”

“…A systematic review of 151 studies showed that rates of bile duct injury (BDI) have been reduced over time (1994–1999: 0.69% (0.52–0.84%) versus 2010–2015: 0.22% (0.02–0.40%), P = 0.011) . However, a recent database review study of BDI showed that less experienced surgeons reported BDI rates three times higher than their more experienced counterparts .…”

“…Similarly, a study reviewing root causes of over 200 BDIs found over 97% were related to non‐technical, predominantly perceptual errors . In response to this and other data, an American Safe Cholecystectomy Task Force identified the most important factors to safety in LC as (1) establishing the critical view of safety, (2) understanding of anatomy, (3) adequate exposure, (4) ability to call a senior colleague for help and (5) recognizing when to convert or abandon . In the Australian context, 9054 laparoscopic cholecystectomies were performed in 64 NSW Public Hospitals in 2016/2017.…”