Bile Duct Injuries after Cholecystectomy: An Individual Patient Data Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Extraction
2.2. Study Details and Endpoints
2.3. Statistical Analysis
3. Results
3.1. Study Population
3.2. Upfront Surgery Group
3.2.1. Distributions of Baseline Characteristics
3.2.2. Distribution of the Primary Endpoint
3.2.3. Univariable Comparisons of Baseline Variables between Failure and Non-Failure of the Surgical Treatment Intervention
3.2.4. Multivariable Analysis Results
3.3. Upfront Endoscopy/IR Group
3.3.1. Distributions of Baseline Characteristics
3.3.2. Distribution of the Primary Endpoint
3.3.3. Univariable Comparisons of Baseline Variables between Failure and Non-Failure of the Endoscopic/IR Treatment Intervention
3.3.4. Multivariable Analysis Results
3.4. Sensitivity Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
- MEDLINE
- SCOPUS
- All fields
Author | Publication Year | Country | N Cases | M/F | Age (y) ° | Initial Classification Used | Primary Repair Site (HPB-H/C-H) |
---|---|---|---|---|---|---|---|
Parmeggiani et al. [137] | 2010 | Italy | 3 | 1/2 | 52 (45–56) | none | 1/2 |
Bernhardt et al. [120] | 2010 | Austria | 1 | 0/1 | 49 | none | 1/0 |
Chiruvella et al. [121] | 2010 | USA | 1 | 0/1 | 65 | Bismuth | 1/0 |
Moo-Young et al. [102] | 2010 | USA | 1 | 0/1 | 64 | none | 1/0 |
Humes et al. [107] | 2010 | England | 3 | 2/1 | 42 (35–63) | none | 3/0 |
Marin et al. [110] | 2010 | USA | 1 | 1/0 | 68 | none | 0/1 |
Selvaggi et al. [60] | 2010 | Italy | 1 | 0/1 | 40 | none | 0/1 |
Ganguly et al. [40] | 2010 | USA | 1 | 1/0 | 51 | none | 1/0 |
Schmidt et al. [32] | 2010 | Germany | 14 | n.r. | n.r. | Neuhaus | 14/0 |
Hwang J.C. et al. [37] | 2011 | Republic of Korea | 1 | 0/1 | 31 | none | 1/0 |
Ball et al. [125] | 2011 | USA | 1 | 0/1 | 27 | none | 1/0 |
Brunet et al. [103] | 2011 | Canada | 1 | 0/1 | 48 | none | 1/0 |
Palermo et al. [94] | 2011 | USA | 1 | 0/1 | 43 | none | 0/1 |
Lau et al. [119] | 2011 | USA | 1 | 1/0 | 30 | none | 1/0 |
Mazer et al. [91] | 2011 | USA | 7 | 1/6 | 41 (22–71) | none | 7/0 |
Yan et al. [73] | 2011 | China | 1 | 1/0 | 41 | Strasberg | 1/0 |
Maurea et al. [93] | 2011 | Italy | 1 | 0/1 | 41 | Bismuth | 1/0 |
Hwang S. et al. [58] | 2011 | Republic of Korea | 1 | 0/1 | 48 | none | 1/0 |
Romano O. et al. [51] | 2011 | Italy | 2 | 1/1 | 50 (45–55) | none | 0/2 |
Choi et al. [39] | 2011 | Republic of Korea | 1 | 0/1 | 34 | none | 1/0 |
Donatelli et al. [126] | 2012 | France | 1 | 1/0 | 51 | none | 1/0 |
Strasberg et al. [118] | 2012 | USA | 8 | 0/8 | n.r. | Strasberg | 8/0 |
Truant et al. [75] | 2012 | France | 3 | 2/1 | 35 (25–43) | Strasberg | 1/2 |
Mohamadnejad et al. [109] | 2012 | Iran | 1 | 0/1 | 68 | none | 1/0 |
Sasahira et al. [76] | 2012 | Japan | 1 | 0/1 | 58 | none | 0/1 |
Olmez et al. [77] | 2012 | Turkey | 1 | 1/0 | 53 | Strasberg | 1/0 |
Addeo et al. [101] | 2013 | France | 6 | 2/4 | 39 (28–46) | Strasberg | 0/6 |
De Werra et al. [122] | 2013 | Italy | 9 | n.r. | n.r. | Strasberg | 9/0 |
Denjalic et al. [96] | 2013 | Bosnia | 1 | 1/0 | 43 | none | 1/0 |
Wojcicki et al. [79] | 2013 | Poland | 2 | 0/2 | 18 (15–21) | Strasberg | 2/0 |
Mungai et al. [92] | 2013 | Italy | 1 | 0/1 | 42 | none | 1/0 |
Macedo et al. [66] | 2013 | USA | 1 | 0/1 | 58 | none | 1/0 |
Majumder et al. [59] | 2013 | USA | 1 | 0/1 | 58 | none | 1/0 |
Parlak et al. [61] | 2013 | Turkey | 7 | 1/6 | 44 (30–82) | none | 7/0 |
Paik et al. [28] | 2013 | Republic of Korea | 1 | 1/0 | 76 | none | 1/0 |
Gluszek et al. [138] | 2014 | Poland | 14 | 3/11 | 45 (29–84) | ATOM | 13/1 |
Buturovic et al. [106] | 2014 | Bosnia | 1 | 1/0 | 40 | none | 1/0 |
Crema et al. [116] | 2014 | Brazil | 1 | 1/0 | 41 | Bismuth | 1/0 |
Odemis et al. [105] | 2014 | Turkey | 1 | 0/1 | 45 | Stewart-Way | 1/0 |
Donatelli et al. [98] | 2014 | France | 16 | 6/10 | 55.5 (31–89) | Strasberg | 16/0 |
Shokouh-Amiri et al. [111] | 2014 | USA | 1 | 0/1 | 71 | none | 1/0 |
Jadrijevic et al. [80] | 2014 | Croatia | 1 | 0/1 | 36 | Bismuth | 0/1 |
Judd et al. [104] | 2014 | USA | 1 | 1/0 | 68 | none | 1/0 |
Laux et al. [83] | 2014 | USA | 1 | 0/1 | 48 | none | 1/0 |
Jalali et al. [97] | 2014 | USA | 1 | 0/1 | 45 | Strasberg | 0/1 |
Yaqub et al. [52] | 2014 | Norway | 1 | 1/0 | 32 | Strasberg | 1/0 |
Sofi et al. [33] | 2014 | USA | 3 | 2/1 | 46 (27–61) | none | 3/0 |
Anantha et al. [34] | 2014 | USA | 2 | 1/1 | 39.5 (29–52) | none | 2/0 |
Sugawara et al. [29] | 2014 | Japan | 14 | 11/3 | 51 (27–81) | Strasberg | 14/0 |
Artifon et al. [141] | 2015 | Brazil | 1 | 0/1 | 63 | none | 1/0 |
Velidedeoglu et al. [81] | 2015 | Turkey | 12 | 2/10 | n.r. | Strasberg | 12/0 |
Odemis et al. [142] | 2015 | Turkey | 1 | 1/0 | 53 | none | 1/0 |
Prasad et al. [67] | 2015 | India | 1 | 0/1 | 36 | Strasberg | 1/0 |
Rai et al. [57] | 2015 | USA | 1 | 0/1 | 54 | none | 1/0 |
Pekolj et al. [30] | 2015 | Argentina | 15 | 7/8 | 44 (23–65) | Strasberg | 5/10 |
Curcio et al. [124] | 2016 | Italy | 1 | 0/1 | 36 | none | 1/0 |
Merrick et al. [85] | 2016 | England | 1 | 0/1 | 48 | Bismuth | 0/1 |
Takahashi et al. [49] | 2016 | Japan | 2 | 0/2 | 78 (73–83) | none | 2/0 |
Hoepfner et al. [38] | 2016 | USA | 1 | 1/0 | 79 | none | 1/0 |
Sasaki et al. [131] | 2017 | Japan | 1 | 1/0 | 78 | none | 1/0 |
Dokmak et al. [88] | 2017 | France | 3 | 1/2 | 38 (26–45) | none | 3/0 |
Dokmak et al. [87] | 2017 | France | 1 | 0/1 | 59 | none | 1/0 |
Ko et al. [108] | 2017 | Republic of Korea | 1 | 1/0 | 51 | none | 1/0 |
Zoričić et al. [86] | 2017 | Croatia | 1 | 1/0 | 78 | Strasberg | 1/0 |
Park et al. [70] | 2017 | Republic of Korea | 1 | 1/0 | 67 | none | 1/0 |
Xu et al. [140] | 2017 | USA | 1 | 0/1 | 32 | none | 1/0 |
Odemis et al. [45] | 2017 | Turkey | 1 | 1/0 | 58 | none | 1/0 |
Meek et al. [53] | 2018 | USA | 1 | 0/1 | 44 | none | 1/0 |
Kohn et al. [132] | 2018 | USA | 7 | n.r. | n.r. | Strasberg | 7/0 |
Dousse et al. [112] | 2018 | France | 1 | 0/1 | 55 | Bismuth | 0/1 |
Elmunzer et al. [127] | 2018 | USA | 1 | 0/1 | 43 | none | 1/0 |
Rifatbegovic et al. [41] | 2018 | Bosnia | 1 | 0/1 | 21 | Strasberg | 1/0 |
Runge et al. [65] | 2018 | USA | 1 | 0/1 | 24 | none | 1/0 |
Lim et al. [54] | 2018 | Australia | 1 | 0/1 | 44 | none | 0/1 |
Kotecha et al. [113] | 2019 | Australia | 1 | 0/1 | 56 | none | 1/0 |
Nezami et al. [136] | 2019 | USA | 7 | 5/2 | 60 (44–76) | none | 7/0 |
Machado et al. [134] | 2019 | Brazil | 1 | 0/1 | 24 | none | 1/0 |
Bonati et al. [133] | 2019 | Italy | 1 | 0/1 | 45 | none | 1/0 |
Acquafresca et al. [129] | 2019 | Argentina | 1 | 1/0 | 64 | none | 1/0 |
Ayloo et al. [128] | 2019 | USA | 1 | 0/1 | 36 | Strasberg | 1/0 |
Battal et al. [100] | 2019 | Turkey | 13 | 4/9 | 46 (19–65) | Strasberg | 13/0 |
Desai et al. [123] | 2019 | India | 1 | 0/1 | 35 | none | 1/0 |
Kumar et al. [82] | 2019 | India | 1 | 0/1 | 42 | Strasberg | 1/0 |
Kwak et al. [71] | 2019 | Republic of Korea | 8 | 2/6 | 49 (29–77) | Bismuth | 8/0 |
Özdemir et al. [63] | 2019 | France | 1 | 0/1 | 42 | Strasberg | 0/1 |
Kohga et al. [56] | 2019 | Japan | 2 | 1/1 | 82.5 (81–84) | none | 0/2 |
Gallagher et al. [36] | 2019 | USA | 1 | 0/1 | 67 | Strasberg | 1/0 |
Martines et al. [27] | 2019 | Italy | 43 | 19/24 | 50 (15–81) | Strasberg | 34/9 |
Lubikowski et al. [130] | 2019 | Poland | 1 | 0/1 | 26 | Bismuth | 1/0 |
Drs et al. [117] | 2020 | Czech Republic | 1 | 1/0 | 45 | Stewart-Way | 1/0 |
Tsai et al. [95] | 2020 | Taiwan | 2 | 1/1 | 55.5 (53–58) | Strasberg | 1/1 |
Hite et al. [115] | 2020 | USA | 1 | 0/1 | 31 | none | 0/1 |
Fan et al. [62] | 2020 | China | 1 | 1/0 | 65 | Stewart-Way | 0/1 |
Vasilidias et al. [64] | 2020 | Greece | 1 | 0/1 | 46 | Strasberg | 0/1 |
Sondhi et al. [47] | 2020 | USA | 1 | 1/0 | 87 | Bergman | 1/0 |
Ferrada et al. [31] | 2020 | Chile | 1 | 1/0 | 65 | Strasberg | 1/0 |
Bowen et al. [99] | 2021 | Ireland | 1 | 0/1 | 30 | none | 1/0 |
Romano L. et al. [69] | 2021 | Italy | 1 | 0/1 | 18 | none | 1/0 |
Wei et al. [90] | 2021 | USA | 1 | 1/0 | 85 | Strasberg | 0/1 |
Lin et al. [135] | 2021 | Taiwan | 1 | 1/0 | 50 | none | 1/0 |
Mistry et al. [26] | 2021 | India | 2 | 0/2 | 53 (30–76) | Strasberg | 2/0 |
Anwar et al. [84] | 2022 | Indonesia | 1 | 0/1 | 32 | none | 1/0 |
Mayer et al. [114] | 2022 | France | 1 | 0/1 | 70 | none | 1/0 |
Torretta et al. [68] | 2022 | Italy | 1 | 1/0 | 65 | Strasberg | 1/0 |
Garcia et al. [74] | 2022 | Brazil | 1 | 0/1 | 39 | none | 1/0 |
Sharma et al. [72] | 2022 | USA | 1 | 0/1 | 62 | none | 1/0 |
Kakati et al. [42] | 2022 | Lebanon | 4 | 2/2 | 38 (30–50) | none | 4/0 |
Emara et al. [46] | 2022 | Egypt | 1 | 1/0 | 58 | none | 1/0 |
D’Ovidio et al. [35] | 2022 | Italy | 1 | 1/0 | 60 | Hannover | 0/1 |
Robles-Medrandra et al. [25] | 2022 | Ecuador | 1 | 0/1 | 24 | Strasberg | 1/0 |
Sucandy et al. [89] | 2023 | USA | 1 | 0/1 | 43 | Strasberg | 1/0 |
Swallow et al. [139] | 2023 | Tanzania | 2 | 0/2 | 43 (40–46) | Bismuth | 2/0 |
Hristov et al. [55] | 2023 | Bulgaria | 1 | 0/1 | 33 | Strasberg | 1/0 |
Rott et al. [48] | 2023 | Germany | 1 | 1/0 | 68 | none | 1/0 |
Abughararah et al. [43] | 2023 | Saudi Arabia | 1 | 1/0 | 85 | Strasberg | 1/0 |
Rathore et al. [78] | 2023 | India | 1 | 0/1 | 43 | Bismuth | 0/1 |
Selleslag et al. [50] | 2023 | Belgium | 1 | 0/1 | 74 | none | 1/0 |
Marti Romero et al. [44] | 2023 | Spain | 1 | 0/1 | 79 | Strasberg | 0/1 |
Pt n. | Age (y)/ Sex | Indication for Surgery | Primary Surgery | BDI Type ° | VI | Timing Diagnosis | Initial Treatment/ Site | Timing Surgical Repair | Further Treatment | Outcome |
---|---|---|---|---|---|---|---|---|---|---|
1 | 78/M | acute calculous cholecystitis | LC, converted | E2 | - | 4 d | HJ/ HPB-H | 9 d | - | death |
2 | 42/F | lithiasis, elective | OC | E2 | - | io | HJ/ HPB-H | 14 d | PTBD, re-do HJ for AS | no further complications |
3 | 50/F | lithiasis, elective | LC | D | - | 5 d | ERCP + stenting/ HPB-H | - | ERCP + ballooning for stricture | no further complications |
4 | 68/F | lithiasis, elective | LC | E2 | - | 58 d | ERCP + stenting, PTBD/HPB-H | - | - | no further complications |
5 | 40/F | lithiasis, elective | OC | D | - | 4 d | E-E A/ C-H | 5 d | PTBD, HJ for AS | no further complications |
6 | 22/M | acute calculous cholecystitis | LC | E2 | - | 26 d | HJ/ HPB-H | 29 d | re-do HJ + LH for AS | no further complications |
7 | 67/M | lithiasis, elective | LC, converted | E2 | - | 45 d | HJ/ HPB-H | 49 d | - | no further complications |
8 | 79/M | acute calculous cholecystitis | LC, converted | D | - | io | HJ/ HPB-H | 1 d | - | no further complications |
9 | 84/M | acute calculous cholecystitis | LC | E4 | - | 3 d | ERCP + stenting/ C-H | 9 d | HJ | no further complications |
10 | 49/M | acute acalculous cholecystitis | LC | E4 | - | 11 d | RH + HJ/ HPB-H | 81 d | - | no further complications |
11 | 62/M | lithiasis, elective | LC | E2 | - | 148 d | HJ/ HPB-H | 153 d | - | no further complications |
12 | 67/M | lithiasis, elective | LC | E3 | - | 10 d | ERCP + stenting/ C-H | 24 d | HJ | no further complications |
13 | 34/F | lithiasis, elective | LC | C | - | 5 d | clips placement/C-H | 7 d | ERCP + stenting/ E-lap | no further complications |
14 | 32/F | lithiasis, elective | LC | E4 | - | io | T-tube insertion/C-H | i.o. | HJ | no further complications |
15 | 33/F | lithiasis, elective | LC | E2 | - | 3 d | HJ/ HPB-H | 4 d | - | no further complications |
16 | 87/M | lithiasis, elective | LC | E4 | RHA | io | HJ + VR/ HPB-H | 1 d | - | no further complications |
17 | 36/M | acute calculous cholecystitis | LC | E2 | - | 4 d | HJ/ C-H | 12 d | PTBD/ ERCP + stenting for stricture | recurrent cholangitis |
18 | 49/M | acute calculous cholecystitis | LC converted | D | - | io | primary suture repair/C-H | i.o. | PTBD/ robotic HJ | no further complications |
19 | 73/F | lithiasis, elective | LC | C | - | 16 d | ERCP + stenting/ C-H | 36 d | laparoscopic leak repair | no further complications |
1. Upfront surgery group | ||
Preoperative risk factors contributing to Surgical Failure Variable | p-value | Odds ratio (95% CI) |
Injury type D and E ° | 0.028 | 3.845 (1.153 to 12.82) |
Immediate attempt of surgical repair | 0.0015 | 3.373 (1.594 to 7.14) |
Repair in a non-specialized center | 0.0001 | 8.317 (2.878 to 24.035) |
2. Upfront endoscopy/IR upfront group | ||
Preoperative risk factors contributing to rndoscopy/IR gailure Variable | p-value | Odds ratio (95% CI) |
Repair in a non-specialized center | <0.0001 | 34.2 (6.45 to 181.32) |
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Baseline Variables | Primary Composite Endpoint |
---|---|
Demographics Technique of cholecystectomy (open vs. laparoscopic) Conversion to open and cause Grade of BDI Associated VI and pattern Timing of BDI diagnosis Timing of surgical repair Methodic of surgical repair Type of endoscopic/IR procedure Site of BDI management (HPB/tertiary care center vs. non-specialized center) | Incidence of treatment intervention failure: Surgical Endoscopic/IR |
Upfront Surgery Group (n = 224) | Upfront Endoscopy/IR Group (n = 109) | p-Value | |
---|---|---|---|
Age, median (IQ range) ° | 47 (36.2–62) | 52 (42–65) | 0.065 |
Male, % (n) ° | 37.1 (75) | 42.2 (43) | 0.40 |
Upfront OC, % (n) | 12.1 (27) | 12 (13) | 0.90 |
LC converted to open, % (n) | 27.9 (55) | 10.4 (10) | 0.001 |
LC converted due to BDI, % (n) | 24.1 (45) | 2.3 (2) | <0.0001 |
Grade of BDI, % (n) °° | <0.0001 | ||
A | 4.9 (11) | 27.5 (30) | |
B | 1.8 (4) | 0.9 (1) | |
C | 5.8 (13) | 16.5 (18) | |
D | 19.6 (44) | 9.2 (10) | |
E | 67.9 (152) | 45.9 (50) | |
BDI type D and E, % (n) °° | 87.5 (196) | 55.1 (60) | <0.0001 |
Associated VI, % (n) | 22.8 (51) | 2.8 (3) | <0.0001 |
Timing of BDI diagnosis, % (n) ° | <0.0001 | ||
within one week | 79.5 (151) | 43.6 (44) | |
after one week | 20.5 (39) | 56.4 (57) | |
Repair HPB/tertiary center, % (n) | 0.025 | ||
yes | 79 (177) | 89 (97) | |
no | 21 (47) | 11 (12) | |
Failure rate, % (n) | 41.1 (92) | 20.2 (22) | <0.0001 |
Mortality rate, % (n) | 10 (4.5) | 0 (0) | 0.025 |
Surgical Failure Group (n = 92) | Surgical Non-Failure Group (n = 132) | p-Value | |
---|---|---|---|
Age > 70 years, % (n) ° | 12.2 (9) | 13.6 (15) | 0.95 |
Male, % (n) ° | 41.5 (34) | 34.2 (41) | 0.37 |
Upfront OC, % (n) | 18.4 (17) | 7.6 (10) | 0.024 |
LC converted to open, % (n) | 50.7 (38) | 13.9 (17) | 0.001 |
LC converted due to BDI, % (n) | 45.3 (34) | 9 (11) | 0.001 |
BDI type D and E, % (n) °° | 94.6 (87) | 82.6 (109) | 0.014 |
Associated VI, % (n) | 26 (24) | 20.4 (27) | 0.40 |
Timing of BDI diagnosis, % (n) ° | 0.57 | ||
within one week | 82.7 (62) | 77.4 (89) | |
after one week | 17.3 (13) | 22.6 (26) | |
Timing of surgical repair, % (n) ° | 0.001 | ||
Immediate (within 1 day) | 59.3 (48) | 34.1 (42) | |
Early (>1 day < 1 week) | 11.1 (9) | 24.4 (30) | |
Delayed (>1 week < 6 weeks) | 21 (17) | 21.2 (26) | |
Late (>6 weeks) | 8.6 (7) | 20.3 (25) | |
Repair HPB/tertiary center, % (n) | <0.0001 | ||
yes | 60.9 (56) | 91.7 (121) | |
no | 39.1 (36) | 8.3 (11) |
Preoperative Risk Factors Contributing to Surgical Failure Variable | p-Value | Odds Ratio (95% CI) |
---|---|---|
Injury type D and E ° | 0.0094 | 4.214 (1.423 to 12.48) |
Immediate attempt of surgical repair | 0.0113 | 2.219 (1.197 to 4.114) |
Repair in a non-specialized center | 0.001 | 4.169 (1.783 to 9.745) |
Endoscopy/IR Failure Group (n = 22) | Endoscopy/IR Non-Failure Group (n = 87) | p-Value | |
---|---|---|---|
Age > 70 years, % (n) ° | 11.1 (2) | 16.9 (14) | 0.80 |
Male, % (n) ° | 44.4 (8) | 41.7 (35) | 0.96 |
Upfront OC, % (n) | 19 (4) | 11.1 (9) | 0.33 |
LC converted to open, % (n) | 11.1 (2) | 10.3 (8) | 0.92 |
LC converted due to BDI, % (n) | 5.8 (1) | 1.4 (1) | 0.55 |
BDI type D and E, % (n) °° | 81.8 (18) | 48.3 (42) | 0.001 |
Associated VI, % (n) | 13.6 (3) | 0 (0) | 0.006 |
Timing of BDI diagnosis, % (n) ° | 0.48 | ||
Within one week | 53.3 (8) | 41.9 (36) | |
After one week | 46.7 (7) | 58.1 (50) | |
Endoscopic treatment, % (n) | 81.8 (18) | 86.2 (75) | 0.85 |
IR treatment, % (n) | 68.2 (15) | 43.7 (38) | 0.07 |
Repair HPB/tertiary center, % (n) | <0.0001 | ||
yes | 59.1 (13) | 96.6 (84) | |
no | 40.9 (9) | 3.4 (3) |
Preoperative Risk Factors Contributing to Endoscopy/IR Failure Variable | p-Value | Odds Ratio (95% CI) |
---|---|---|
Injury type D and E ° | 0.02 | 4.607 (1.263 to 16.804) |
Repair in a non-specialized center | 0.0002 | 18.620 (4.093 to 84.710) |
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Vincenzi, P.; Mocchegiani, F.; Nicolini, D.; Benedetti Cacciaguerra, A.; Gaudenzi, D.; Vivarelli, M. Bile Duct Injuries after Cholecystectomy: An Individual Patient Data Systematic Review. J. Clin. Med. 2024, 13, 4837. https://doi.org/10.3390/jcm13164837
Vincenzi P, Mocchegiani F, Nicolini D, Benedetti Cacciaguerra A, Gaudenzi D, Vivarelli M. Bile Duct Injuries after Cholecystectomy: An Individual Patient Data Systematic Review. Journal of Clinical Medicine. 2024; 13(16):4837. https://doi.org/10.3390/jcm13164837
Chicago/Turabian StyleVincenzi, Paolo, Federico Mocchegiani, Daniele Nicolini, Andrea Benedetti Cacciaguerra, Diletta Gaudenzi, and Marco Vivarelli. 2024. "Bile Duct Injuries after Cholecystectomy: An Individual Patient Data Systematic Review" Journal of Clinical Medicine 13, no. 16: 4837. https://doi.org/10.3390/jcm13164837