Minimally invasive repair of iatrogenic bile duct injuries: a systematic review and meta-analysis.

BACKGROUND

Bile duct injuries (BDI) are a rare but serious complication of cholecystectomy, associated with substantial morbidity and clinical burden. However, no consensus has been reached on the optimal surgical approach for the management of BDI. This meta-analysis aims to evaluate the safety and efficacy of minimally invasive surgery (MIS) for the repair of iatrogenic BDI.

METHODS

Cochrane, CINAHL, Ovid Embase and Medline were searched from their inception date to March 2025. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines were followed. The review was registered prospectively on PROSPERO (CRD420251009530).

RESULTS

A total of 246 patients with MIS for BDI repair from sixteen studies were included in the analysis. The pooled mean operative time was 219 min (95% CI: 183-255), and the pooled mean hospital stay was 6.5 days (95% CI: 5.2-7.8). The pooled mean estimated blood loss was 122 mL (95% CI: 84-160). The overall postoperative morbidity was 16.2% (95% CI: 0.092-0.233, I2 = 60%, n = 47). The rate of biliary fistula was 4.8% (95% CI: 0.021-0.075, I2 = 0%, n = 13), while the rate of stricture was 3.9% (95% CI: 0.015-0.063, I2 = 0%, n = 9). The rate of conversion to open surgery was 2.3% (95% CI: 0.002-0.044, I2 = 0%, n = 4), while the rate of readmission was 4.5% (95% CI: 0.003-0.086, I2 = 0%, n = 7). The reoperation rate was 3.0% (95% CI: 0.009-0.052, I2 = 0%, n = 8) and there was no surgery-associated mortality across the included studies.

CONCLUSIONS

MIS appears safe and effective for the repair of iatrogenic BDIs and is associated with acceptable morbidity and low reoperation rate. However, given the lack of high-level evidence, further studies are needed to ascertain these findings.