Iatrogenic gallbladder perforation during laparoscopic cholecystectomy and outcomes: a systematic review and meta-analysis.

AIMS: We aimed to compare the outcomes of iatrogenic gallbladder perforation (IGP) versus no gallbladder perforation in patients undergoing laparoscopic cholecystectomy. METHODS: A systematic review and meta-analysis was conducted in compliance with PRISMA statement standards. We searched the MEDLINE, EMBASE, CINAHL Scopus, and CENTRAL to identify eligible studies. The last search was run on 17 October 2021. The outcome of interest included surgical site infection (SSI), postoperative collection, operative time, and length of hospital stay. Random effects modelling was applied to calculate pooled outcome data. The certainty of evidence was assessed using GRADE system. RESULTS: Analysis of 5366 patients from 11 observational studies suggested that IGP during laparoscopic cholecystectomy does not increase the risk of SSI (OR: 1.48, 95% CI 0.57-3.86, P = 0.42) and postoperative collection (RD: 0.00, 95% CI - 0.00-0.01, P = 0.41) but may result in longer operative time (MD 10.28 min, 95% CI 7.40-13.16, P < 0.00001) and length of hospital stay (MD 0.51 days, 95% CI 0.15-0.87, P = 0.005). The results remained consistent through sensitivity analyses. The quality of available evidence was judged to be moderate, and the GRADE certainty of the evidence was judged to be high. CONCLUSIONS: The best available evidence suggests that IGP during laparoscopic cholecystectomy may not increase the risk of SSI and postoperative collection but may result in longer operative time and length of hospital stay. Whether prompt retrieval of spilled stones, adequate peritoneal irrigation, and intraoperative use of prophylactic antibiotic contribute to the above findings remains unknown.

Procedural outcomes of laparoscopic caudate lobe resection: A systematic review and meta-analysis.

A systematic review was conducted in compliance with PRISMA statement standards to identify all studies reporting outcomes of laparoscopic resection of benign or malignant lesions located in caudate lobe of liver. Pooled outcome data were calculated using random-effects models. A total of 196 patients from 12 studies were included. Mean operative time, volume of intraoperative blood loss, and length of hospital stay were 225 minutes (95% confidence interval [CI], 181-269 minutes), 134 mL (95% CI, 85-184 mL), and 7 days (95% CI, 5-9 days), respectively. The pooled risk of need for intraoperative transfusion was 2% (95% CI, 0%-5%). It was 3% (95% CI, 1%-6%) for conversion to open surgery, 6% (95% CI, 0%-19%) for need for intra-abdominal drain, 1% (95% CI, 0%-3%) for postoperative mortality, 2% (95% CI, 0%-4%) for biliary leakage, 2% (95% CI, 0%-4%) for intra-abdominal abscess, 1% (95% CI, 0%-4%) for biliary stenosis, 1% (95% CI, 0%-3%) for postoperative bleeding, 1% (95% CI, 0%-4%) for pancreatic fistula, 2% (95% CI, 1%-5%) for pulmonary complications, 1% (95% CI, 0%-4%) for paralytic ileus, and 1% (95% CI, 0%-4%) for need for reoperation. Although the available evidence is limited, the findings of the current study might be utilized for hypothesis synthesis in future studies. They can be used to inform surgeons and patients about estimated risks of perioperative complications until a higher level of evidence is available.