Review
English
Mohamed Algabsi, Hamed Rafe, Bubaker Swissi
Department of Surgery, Faculty of Medicine, Omar Al-Mukhtar University Derna, Libya
JMJ 2009,Vol.9, No.1: 16-18
Abstract
Background: Major bile duct injuries remain a significant cause of morbidity and even death after laparoscopic cholecystectomy. Bile duct injury is a severe and potentially life-threatening complication of laparoscopic cholecystectomy. The incidence of bile duct injuries during laparoscopic cholecystectomy is varied. Objective: To perform a meta-analysis of laparoscopic cholecystectomy studies and compare results concerning complications (particularly bile duct injury). Methodology: Articles identified via a MEDLINE (the National Library of Medicine’s computerized database) search were evaluated according to standard criteria. Data regarding the patient sample, study methods, and outcomes of cholecystectomy were abstracted and summarized across studies. Results: Outcomes of laparoscopic cholecystectomy were examined for 225,187 patients reported on in 5 studies and compared with outcomes of bile duct injury. Laparoscopic cholecystectomy appeared to have a higher common bile duct injury rate. Running an analysis using MetaStat program, the following was obtained: 2 Restricted Log Likelihood was 57.4, Type III tests of fixed effect: f= 2.6, P= 0.18, Covariance estimate = 65926.7, Multiple Regression R= 0.99, F= 6270.1, P<0.001, Mean of bile duct injury = 184.2 + 229.7, Mean of total laparoscopy= 45037 + 5754.1, Mean prevalence = 0.408%. Potentials: Meta-analysis allows the investigator to define the problem or health phenomenon [with all its dimensions] and study factors that could affect it from the available data in the literature and/or pooled data base within reasonable time and minimal costs. Moreover, it allows suggesting solutions or evaluating the current solutions for the problem. Limitations: The limitations of meta-analysis are based on the deficiencies of research design, review methods, medical lab or techniques, and analytical models used in these scientific studies, particularly with summary data. However, these could be minimized through well researched design with clear criteria for inclusion and exclusion. Conclusions: This study confirms a higher incidence of BDI during LC. It highlights the relevance of the number of previously performed LCs. The need for correct procedures, adequate expertise of the repairing surgeon in BDI repairs, and a multidisciplinary approach in the management of BDI is emphasized. Keywords: Epidemiological methods, Meta-analysis, Pooled analysis, Reviews, Risk Factors, Potentials, Limitations. Link/DOI: http://www.jmj.org.ly/PDF/Spring2009/16.pdf