TP6.1.4 Risk factors for post-cholecystectomy bile duct injuries: Systematic review and meta-analysis

Aims Bile duct injury (BDI) is a major complication of cholecystectomy resulting in long-term consequences. The relatively low incidence (0.23% – 1.5%) of BDI makes the identification of risk factors challenging. The aim of this study was to systematically analyse available literature on BDI post-cholecystectomy to provide an update on the incidence and determine current risk factors. Methods The study was pre-registered on PROSPERO (CRD42020177318). A search was conducted of MEDLINE, EMBASE, Scopus, Cochrane Central, Web of Science databases and the grey literature from inception to February 2020. 1583 unique papers were identified and screened for eligibility. English language, retrospective and prospective studies were included where the population age was > 16 and underwent cholecystectomy. Results Outcomes analysed were incidence of BDI and risk estimates for possible risk factors. 30 studies (6,420,667 patients) were included in the meta-analysis. Gender, BMI>30, acute cholecystitis (AC), emergent surgery, the operative approach, intraoperative cholangiography (IOC) and the impact of surgeon’s experience were analysed. Male gender and AC were determined to be statistically significant risk factors (OR 1.25 (1.13-1.39)) and 1.74 (1.27-2.39) respectively). Furthermore, IOC use was found to be significantly associated with BDI risk (OR 1.27 (1.17 – 1.37), while BMI>30, open surgical approach, emergent surgery and surgeon’s experience were not statistically significant; however, significant heterogeneity among included studies limited the interpretation of these factors. Conclusion Male gender and AC were found to be predictors of BDI, while better quality evidence is needed to show the effect of other factors.