Bile duct injury repair after laparoscopic cholecystectomy: a call for standardized reporting

Background: Bile duct injuries (BDI) represent a severe complication after laparoscopic cholecystectomy (LC). The surgical management of BDI is challenging and current recommendations on optimal timing of repair are not consistent. The aim of this study was to analyze the quality of reporting of timing in BDI repair. Methods: The MEDLINE, EMBASE and The Cochrane databases were systematically screened up to December 2016. All studies reporting timing of BDI repair after LC were assessed for eligbility. Results: A total of 371 abstracts were screened and 15 studies were analysed, including 12,032 patients. Overall 2,327 BDI were reported and 61% (n = 1422) were classified as major. Three different classification systems were used to describe major BDI: Strassberg in 24% (n = 348), Bismuth in 11% (n = 163), Stewart Way in 21% (n = 307). A classification was lacking completely in 4 studies including 43% (n = 624) of patients. Timing of BDI repair was described as immediate (36%, n = 499), early (27%, n = 376), delayed (26%, n = 369) or late (10%, n = 143). Standardization of defintion for timing of repair was remarkably poor. Definitions for immediate repair ranged from <24h- 6weeks after LC, while early repair ranged from < 24h- 12 weeks. Likewise, delayed ( > 24h- > 12weeks) and late repair (>6 weeks) showed a broad overlap. Conclusion: Lack of standardization among studies does not allow a conclusive recommendation on optimal timing of BDI repair after LC. This finding suggests a need for a standardized reporting system of BDI repair.