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Background <p>Despite ongoing controversies in the management of bile duct injuries (BDIs), current clinical guidance remains limited. To address this gap, a systematic review and meta-analysis were undertaken to clarify and synthesize the available evidence and inform the development of evidence-based recommendations for a forthcoming guideline by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).</p> Methodology <p>A systematic review was conducted, incorporating a comprehensive literature search through December 31, 2024, to address four predefined key questions (KQs) regarding the timing of BDI repair, use of minimally invasive surgery for BDI repair, operative vs non-operative management of BDI, and hepaticojejunostomy vs hepaticoduodenostomy for bilioenteric repairs. The review included both randomized controlled trials (RCTs) and comparative observational studies, with meta-analyses performed when appropriate. The review was conducted in accordance with PRISMA 2020 guidelines.</p> Results <p>For KQ1, 8 studies showed early repair was associated with higher reoperation (Odds Ratio (OR): 3.31, 95% CI: 1.56–7.03), stricture (OR: 7.41, 95% CI: 2.07–26.52), and mortality (OR: 2.83, 95% CI: 1.15–6.95) rates compared to late repair. For KQ2, one observational study found no differences between MIS and open repair. For KQ3, non-operative management had higher reoperation (OR: 16.60) and stricture (OR: 2.44) rates compared to operative management. For KQ4, two studies showed no differences between hepaticojejunostomy and hepaticoduodenostomy in stricture or reintervention.</p> Conclusion <p>Delayed repair for BDI was found to reduce reoperation, stricture, and mortality rates compared to early repair. MIS and open repair yield similar outcomes, while operative management outperforms non-operative approaches for major BDIs. Hepaticojejunostomy and hepaticoduodenostomy show comparable results.</p>

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SAGES–AHPBA 2025: a systematic review and meta-analysis on the surgical management of bile duct injury following cholecystectomy

  • 期刊论文

  • 发表日期：

    2025年11月5日

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  • Ali Esparham,
  • Elisa C. Calabrese,
  • Olivia Ganescu,
  • Sarah Choksi,
  • Kathleen Park,
  • Karan Kumar,
  • Bright Huo,
  • Dena Shehata,
  • Ahmed Abou-Setta,
  • Ivan D. Florez,
  • Bethany J. Slater,
  • Kevin El-Hayek

摘要

Background

Despite ongoing controversies in the management of bile duct injuries (BDIs), current clinical guidance remains limited. To address this gap, a systematic review and meta-analysis were undertaken to clarify and synthesize the available evidence and inform the development of evidence-based recommendations for a forthcoming guideline by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).

Methodology

A systematic review was conducted, incorporating a comprehensive literature search through December 31, 2024, to address four predefined key questions (KQs) regarding the timing of BDI repair, use of minimally invasive surgery for BDI repair, operative vs non-operative management of BDI, and hepaticojejunostomy vs hepaticoduodenostomy for bilioenteric repairs. The review included both randomized controlled trials (RCTs) and comparative observational studies, with meta-analyses performed when appropriate. The review was conducted in accordance with PRISMA 2020 guidelines.

Results

For KQ1, 8 studies showed early repair was associated with higher reoperation (Odds Ratio (OR): 3.31, 95% CI: 1.56–7.03), stricture (OR: 7.41, 95% CI: 2.07–26.52), and mortality (OR: 2.83, 95% CI: 1.15–6.95) rates compared to late repair. For KQ2, one observational study found no differences between MIS and open repair. For KQ3, non-operative management had higher reoperation (OR: 16.60) and stricture (OR: 2.44) rates compared to operative management. For KQ4, two studies showed no differences between hepaticojejunostomy and hepaticoduodenostomy in stricture or reintervention.

Conclusion

Delayed repair for BDI was found to reduce reoperation, stricture, and mortality rates compared to early repair. MIS and open repair yield similar outcomes, while operative management outperforms non-operative approaches for major BDIs. Hepaticojejunostomy and hepaticoduodenostomy show comparable results.