Biliary Leakage after Laparoscopic Cholecystectomy versus Open Cholecystectomy

Abstract Background: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gallstones. In spite of the advantages of a distinctly faster recovery and better cosmetic results, the laparoscopic approach bears a higher risk for iatrogenic bile duct injury and injury of the right hepatic artery. Bile leak after laparoscopic cholecystec-tomy is uncommon but can occur in 0.3-2.7% of patients. A bile leak may result in a biliary fistula, a subhepatic/subphrenic collection and localised or generalised peritonitis. Despite the widespread notion that the risk of bile leak is higher after LC, there is a scarcity in the published literature that directly compared the risk of bile leak after LC versus open cholecys-tectomy. Aim of Study: To provide cumulative data about the outcome of biliary leakage after laparoscopic versus open cholecystectomy. Patients and Methods: In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from their inception till December 2018. The search retrieved 12157 unique records. We then retained 45 potentially eligible records for full-texts screening. Finally, 17 studies were included in the present systematic review and meta-analysis. Data Extrac-tion: If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Results: In terms of the primary outcomes of the present study, the overall effect estimates showed that LC significantly increased the risk of bile leak compared to OC (OR 2.01, 95% CI [1.3-3.09]; p=0.002); the pooled studies showed no signif-icant heterogeneity (p=0.74; I2=0%). Conclusion: Surgeons experienced a very low rate of postoperative bile leak following laparoscopic or open chole-cystectomy; however, the risk of bile leak appears to be higher with laparoscopic compared to open cholecystectomy. The present systematic review and meta-analysis showed that the laparoscopic cholecystectomy significantly increased the risk of bile leak compared to open cholecystectomy. These data draw attention to the importance of early identification of patients, at high risk of bile leak, as it may allow specific measures or conversion to open cholecystectomy.