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Risk factors and mitigating measures associated with bile duct injury during cholecystectomy: meta-analysis
Rowan Burns1, Katie L Connor1, Rachel V Guest1
1Department of Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, UK.
BJS Open
|August 2, 2025
Summary
Male sex and acute cholecystitis are key risk factors for bile duct injury during cholecystectomy. Preoperative risk assessment for these factors can improve patient decision-making and surgical outcomes.
Area of Science:
- Gastrointestinal Surgery
- Surgical Safety
- Biliary Tract Surgery
Background:
- Cholecystectomy carries a risk of iatrogenic bile duct injury.
- Identifying risk factors and preventative measures is vital for surgical outcomes.
- This meta-analysis synthesizes evidence on bile duct injury risks and mitigation in cholecystectomy.
Purpose of the Study:
- To identify and synthesize high-quality evidence on risk factors for bile duct injury (BDI) after cholecystectomy.
- To evaluate the effectiveness of potential mitigating measures.
- To inform surgical practice and patient consent processes.
Main Methods:
- A comprehensive literature search adhering to PRISMA guidelines was performed.
- Meta-analyses of risk estimates from 31 studies (1989-2016) involving 6,513,599 cholecystectomies were conducted.
- Random-effects models were used to address heterogeneity in risk estimates.
Main Results:
- Male sex (aOR 1.27) and acute cholecystitis (aOR 1.74) were identified as primary risk factors for bile duct injury.
- The critical view of safety showed no statistically significant association with reduced BDI.
- Routine intraoperative cholangiogram use was not significantly linked to lower BDI incidence (aOR 0.92).
Conclusions:
- Male sex and acute cholecystitis significantly elevate the risk of bile duct injury post-cholecystectomy.
- Preoperative risk stratification for these factors is recommended.
- This aids informed shared decision-making and consent for patients undergoing cholecystectomy.
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