Meta Analysis For High Risk Factors Of Bile Duct Injury Associated With Laparoscopic Cholecystectomy

Objective: To systematically evaluate the high risk factors of bile duct injury associated with laparoscopic cholecystectomy,and in order to provide evidence-based medical basis for preventing and reducing bile duct injury associated with laparoscopic cholecystectomy.Methods: The case-control studies on the high risk factors of bile duct injury associated with laparoscopic cholecystectomy were searched in Pubmed,Embase,Web of science,Cochrane library,CNKI,Wanfang Database,CBM and VIP from January 2011 to December 2020.The quality evaluation of the literatures was performed by using the Newcastle-Ottawa Scale.The meta analysis was performed using Rev Man 5.3 to calculate the odds ratio values of the 11 common high risk factors and their 95%confidence interval.Results: A total of 26 studies were included,involving 81056 patients with laparoscopic cholecystectomy,of which 661 had bile duct injury,and the incidence of bile duct injury was 0.82%.The meta analysis results showed that,lack of operator experience(OR=4.30,95%CI: 2.47～7.49,P<0.00001),abnormal anatomy of gallbladder triangle(OR=10.37,95%CI:5.75～18.71,P<0.00001),dense adhesion of gallbladder triangle(OR=4.22,95%CI: 2.05～8.69,P<0.0001),short gallbladder tube length(OR=3.77,95%CI: 1.92～7.37,P=0.0001),abnormal thickness of gallbladder wall(OR=3.59,95%CI: 2.63～4.90,P<0.00001),obstruction of gallbladder neck or gallbladder duct(OR=3.58,95%CI: 2.68～4.79,P<0.00001),acute phase of cholecystitis(OR=2.17,95%CI: 1.12～4.18,P=0.02),abnormal liver function before surgery(OR=2.01,95%CI: 1.56～2.58,P<0.00001),age(OR=1.76,95%CI: 1.18～2.64,P=0.006)and male(OR=1.30,95%CI:1.03～1.65,P=0.03)might increase the risk of bile duct injury associated with laparoscopic cholecystectomy.The type of surgery(emergency/elective)(OR=1.15,95%CI: 0.76～1.75,P=0.50)was not associated with the risk of bile duct injury associated with laparoscopic cholecystectomy.Conclusion: Lack of operator experience,abnormal anatomy of gallbladder triangle,dense adhesion of gallbladder triangle,short gallbladder tube length,abnormal thickness of gallbladder wall,obstruction of gallbladder neck or gallbladder duct,acute phase of cholecystitis and abnormal liver function before surgery are major high risk factors of bile duct injury associated with laparoscopic cholecystectomy.