Cubisino Antonio, Dreifuss Nicolas H, Cassese Gianluca, Bianco Francesco M, Panaro Fabrizio
Division of General, Minimally Invasive and Robotic Surgery Unit, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA.
Department of Clinical Medicine and Surgery, Minimally Invasive and Robotic HPB Surgery Unit, Federico II University, Naples, Italy.
Updates Surg. 2023 Jan;75(1):31-39. doi: 10.1007/s13304-022-01392-5. Epub 2022 Oct 7.
Major bile duct injuries (BDIs) may require complex surgical repairs that are usually performed with a conventional open approach. This study aims to analyze current evidence concerning the safety and the outcomes of the minimally invasive (MI) approach for biliary anastomosis in post-cholecystectomy BDIs. A systematic search of MEDLINE, Embase, and Web-Of-Science indexed studies involving MI (laparoscopic or robotic) biliary anastomosis in patients with iatrogenic BDIs was performed. The quality of the studies was assessed using the MINORS criteria. A total of 13 studies involving 198 patients were included. One hundred and twenty-five patients (63.1%) underwent a laparoscopic biliary anastomosis, while 73 (36.1%) received an analogue robotic procedure. All the included BDIs were types D and E (E1-E5). The mean OT varied between 190 and 330 (mean = 227) minutes. Ten studies reported the mean intraoperative blood loss that ranged between 50 and 252 (mean = 135.9) mL. No conversions occurred in the robotic series, while four patients required conversion to open surgery among the laparoscopic ones. The mean length of postoperative hospital stay was 6.3 days. The reported overall morbidity was similar among the robotic and laparoscopic series. During the follow-up period, no surgery-related mortality occurred. A growing number of referral centers are showing the safety and feasibility of the MI approach for biliary anastomosis in patients with major BDIs. Further prospective comparative studies are needed to draw more definitive conclusions.
主要胆管损伤（BDIs）可能需要进行复杂的手术修复，通常采用传统的开放手术方式。本研究旨在分析有关微创（MI）方法用于胆囊切除术后BDIs患者胆管吻合术的安全性和结局的现有证据。对MEDLINE、Embase和Web of Science索引的涉及医源性BDIs患者的MI（腹腔镜或机器人）胆管吻合术的研究进行了系统检索。使用MINORS标准评估研究质量。共纳入13项研究，涉及198例患者。125例患者（63.1%）接受了腹腔镜胆管吻合术，而73例（36.1%）接受了类似的机器人手术。所有纳入的BDIs均为D型和E型（E1 - E5）。平均手术时间在190至330分钟之间（平均 = 227分钟）。10项研究报告了平均术中失血量，范围在50至252毫升之间（平均 = 135.9毫升）。机器人手术组未发生中转，而腹腔镜手术组有4例患者需要中转开腹手术。术后平均住院时间为6.3天。机器人手术组和腹腔镜手术组报告的总体发病率相似。在随访期间，未发生与手术相关的死亡。越来越多的转诊中心显示，MI方法用于主要BDIs患者胆管吻合术具有安全性和可行性。需要进一步进行前瞻性比较研究以得出更明确的结论。
