Systematic review of cystic duct closure techniques in relation to prevention of bile duct leakage after laparoscopic cholecystectomy

Table 4 Outcomes of non-comparative studies

Study, year, country	Study design		Intervention	No. of patients	No. of complicated cases	CDL	Biloma/abcess	BDI	Failure of technique
Harmonic scalpel/ shears /stapler
Jain[27], 2011, India	RCT5		Harmonic shears	100	0 (exclusion criterium)	0	0	NR	NR
Ramos[44], 2015, Brazil	PS		Harmonic shears	125	0 (exclusion criterium)	0	NR	NR	NR
Patel[45], 2010, United Kingdom	PS		Harmonic scalpel (LCS-5, Ethicon)2	100	NR	1	NR	1 (D)	NR
Westervelt[46], 2004, United States	PS		Harmonic scalpel (unknown)	100	NR	0	NR	NR	2
Power[47], 2000, Ireland	PS		Harmonic scalpel (Ultracision, Ethicon Endo-Surgery) and clip	282	101	2	NR	NR	NR
Lee[28], 2011, South Korea	RS		Endo-GIA (US Surgical Corp.)1	921	90	0	NR	4 (D)	NR
Tebala[29], 2006, Italy	RS		Harmonic shears (Ultracision, Ethicon Endo- Surgery)	100	0 (exclusion criterium)	0	1/NR	0	2
Ligature
Shah[48], 2010, Nepal	PS		Intracorporeal single ligation	80	19	0	NR	NR	NR
Carvalh[49], 2009, Brazil	PS		Surgical knots (2-0 polyester)4	1000	NR	0	NR	0	NR
Talebpour, 2007, Iran[50]	PS		Absorbable sutures and intracorporeal knots	200	25	0	NR	1 (B)	18
Suo[36], 2013, China	RS		Absorbable thread (VICRYL_ W9215, Ethicon)	1096	296	0	NR /0	0	NR
Golash[37], 2008, Oman	RS		Intracorporeal ligation (3/0 Vicryl)	1000	NR	0	NR	NR	0
Fullum[38], 2005, United States	RS		Two 2–0 PDS Endoloops (Ethicon Endo-Surgery)	105	22	0	NR	NR	NR
Locking clips
Leung[39], 1996, Hong Kong	RS		PDS-clip (Ethicon Endo-surgery)	272	94	3	4 intra-peritoneal collections	NR	45 (30 in complicated group)
Clips
Sinha[40], 2012, India		RS	Ligaclip (titanium clip, Ethicon)4	756	NR	4	NR	NR	NR
Agresta[41], 2011, Italy		RS	Titanium clips4	932	123	1	NR	NR	NR
Feroci[32], 2011, Italy		RS	Polymeric absorbable clip	664	NR	0	0	NR	NR
Ou[42], 2009, China		RS	Clips	10000	NR	6	NR	0	NR
Ojima[35], 2007, Japan		RS	Clips	1127	NR	3	NR	23	NR
Lee[33], 2004, Taiwan		RS	Clips4	1009	78	5	NR/1	2 (D)	NR
Dolan[43], 1999, Nothern Ireland		RS	Titanium clips	303	18	0	1 / 0	NR	0
Wise Unger[30], 1996, United States		RS	Clips	22165	NR	58	NR	NR	NR
Feussner[31], 1991, Germany		RS	Clips	178	28	1	NR	NR	NR
Other
Lewandowski[34], 2006, Poland	RS		LigaSure (Valleylab)	129	NR	0	NR	2 (1B, 1D)	NR

Amsterdam classification was used to identify the severity of the bile duct injuries: B: Major bile duct leaks with or without concomitant biliary strictures; C: Bile duct strictures without bile leakage; D: Complete transection of the duct with or without excision of some portion of the biliary tree.

¹Only in patients with an inflamed an dilated cystic duct (> 1.0 cm);

²Only in patients with an cystic duct < 5 mm; ³severity unknown;

⁴In patients undergoing MLC (mini LC: three ports) or SILC;

⁵Method of closure not described in one study arm, therefore not used as comparative cohort. CDL: Cystic duct leakage; BDI: Bile duct injury; RS: Retrospective study design; PS: Prospective study design; CD: Cystic duct; LC: Laparoscopic cholecystectomy.