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

Philip H. Pucher*, L. Michael Brunt, Neil Davies, Ali Linsk, Amani Munshi, H. Alejandro Rodriguez, Abe Fingerhut, Robert D. Fanelli, Horacio Asbun, Rajesh Aggarwal, on behalf of the SAGES Safe Cholecystectomy Task Force

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

41 Citations (Scopus)
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Abstract

Background: Laparoscopic 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. Methods: PubMed, 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. Results: One 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. Conclusions: Overall, 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.

Original languageEnglish
Pages (from-to)2175-2183
Number of pages9
JournalSurgical Endoscopy
Volume32
Issue number5
Early online date19 Mar 2018
DOIs
Publication statusPublished - 1 May 2018

Keywords

  • Bile duct injury
  • Bile leak
  • Cholecystectomy
  • Laparoscopy
  • Open
  • Outcomes

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