Clinical Features And Experience Of Delayed Bile Leakage After Laparoscopic Cholecystectomy In China

Objective:To explore the clinical features and experience of delayed bile leakage after laparoscopic cholecystectomy in China.Methods:By searching all Chinese databases such as China National Knowledge Infrastructure(CNKI),CQVIP Database,Wanfang Database,and SinoMed,all the literatures on the delayed bile leakage after laparoscopic cholecystectomy(LC)were performed until November 2019.Documents that did not meet the inclusion criteria were screened out,and 89 articles from 89 units were retained,with a total of 578patient data.The raw data were recorded using Excel and SPSS 23.0 was used for data analysis.Results:1.There were 258 cases in which gender could be determined,male:female=1:1.5.There were 29 cases with specific age,with an average age of(43.0±13.5)years.Among 213 cases,67.14%were chronic or atrophic gallbladder disease.There were156 cases in which the intraoperative situation could be clarified,and 76.28%of the patients had a smooth or easy operation.2.Among the 43 units,there were 15 second-level units and 28 third-level units,and the incidence rates of delayed bile leakage were 0.073%and 0.056%,respectively.The overall incidence of delayed bile leakage was 0.060%,and there was a correlation between the annual corrected incidence and the total number of operations(r_s=-0.794,P=0.000).3.2.77%of the patients had clear inducement,mostly related to dietary factors;65.74%of patients showed symptoms of abdominal pain,and the rest showed jaundice 0.69%,abdominal distension 11.94%,low back pain 0.17%,bile drainage through drainage tube 0.69%,4.33%of peritoneal effusion.4.The average diagnosis time of bile leakage was(7.89±6.21)days.60.1%of the patients were diagnosed by ultrasound+abdominal puncture,followed by ERCP and its combined method of 22.5%,and 14.8%of surgical exploration method.7 cases were misdiagnosed(1.21%).5.There are 443 cases where the type of bile leakage can be identified.Capillary bile duct leakage/aberrant bile duct leakage was 43.57%,gallbladder tube leakage was 19.64%,parahepatic tube leakage was 3.16%,right hepatic tube leakage was 9.93%,common hepatic duct leakage was 13.09%,common bile duct leakage10.61%.6.The causes of bile duct leakage were identified in 354 cases,including 50.28%aberrant bile duct injury,35.88%extrahepatic main biliary duct thermal injury,3.95%ischemic necrosis at the stump of the gallbladder duct,3.11%capillary bile duct injury in the gallbladder bed,2.82%ligature clip dislodgement and displacement,and 3.95%extrahepatic bile duct variation.7.The main treatment methods were surgical treatment(37.20%),interventional treatment(minimally invasive treatment,endoscopic treatment)(14.36%),combined treatment(41.70%)(that is,surgical treatment,minimally invasive treatment and endoscopic treatment in combination of the two or three);76.68%of the gallbladder bed capillary bile duct leakage/aberrant bile duct leakage,90.80%of the gallbladder tube leakage treatment methods are mainly surgical and combined treatment;parahepatic tube leakage,right hepatic tube leakage common hepatic duct leakage and common bile leakage were mainly treated by surgery,which were 85.71%,63.64%,63.79%and 55.32%.8.There were 418 patients with known length of stay.The length of stay was statistically significant in surgical treatment,interventional treatment,and combination therapy(H=11.333,P=0.003).The median length of stay was 12.00days and 14.00 days,12.60 days.The interventional treatment group and combination treatment group,the interventional treatment group and the surgical treatment group were all statistically significant(adjusted P value were P=0.002,P=0.033).In the surgical group,the length of hospital stay was not statistically significant in laparotomy and laparoscopic surgery(H=0.950,P=0.330).In the combined treatment group,the length of stay was not statistically significant in the treatment mode of surgical combined intervention and minimally invasive combined endoscopy(H=3.602,P=0.058).Among the types and treatment methods of bile duct leakage,the three treatment methods of capillary duct leakage/aberrant duct leakage in the gallbladder bed had statistical significance(H=93.280,P=0.000),and the pairwise comparison between the groups was significant(all adjustment P<0.05).The average rank was 97.27,123.56,and 43.24,respectively.There was statistical significance among the three types of treatment for cystic duct leakage(H=22.065,P=0.000),and the length of stay was statistically significant between the surgical treatment group and the combined treatment group(adjustment P=0.000),with average rank of 16.85 and 38.17,respectively.There was no statistically significant difference in treatment between right hepatic duct leakage and common hepatic duct leakage(H=2.359,P=0.125;H=2.932,P=0.231).The difference in hospital stay between the surgical treatment group and the combined treatment group for common bile duct leakage was statistically significant(H=5.461,P=0.019),and the average ranks were 14.68 and 8.32,respectively.9.In 95 cases,the size of the leak was clear,with an average of(3.48±1.45)mm.There was no statistical significance between the type of bile leakage and the size of the leak(H=8.017,P=0.091),and there was no correlation between the size of the leak and the length of hospital stay.Conclusion:1.Delayed bile leakage after LC surgery is mostly in middle-aged people with chronic or atrophic gallbladder disease.2.The incidence of delayed bile leakage after LC is low(0.060%).The incidence of delayed bile leakage after LC is negatively correlated with the total number of LC.3.The causes of delayed bile leakage after LC are mainly aberrant bile duct injury and extrahepatic main biliary duck thermal injury.The remaining causes include biliary ischemic necrosis,ligature clip dislodgement and displacement,gallbladder bed capillary bile duct injury,extrahepatic bile duct variation.4.The treatment methods of delayed bile leakage after LC are mainly surgical treatment,endoscopic treatment,minimally invasive treatment,and a combination of the above.