To investigate the risk factors of bile leakage after primary duct suture of laparoscopic common bile duct exploration (LCBDE).

Clinical studies related to the risk factors of bile leakage after primary suture of LCBDE were searched from PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data and Chongqing VIP from January 1, 1990 to May 1, 2022. The Chinese searching words included common bile duct stone, laparoscopic common bile duct exploration, bile leakage and risk factor. The English searching words consisted of choledocholithiasis, common bile duct stone, laparoscopic common bile duct exploration, LCBDE and bile leakage. The indexes which were reported in ≥3 clinical studies were subject to Meta-analysis.

7 studies of 930 patients were finally selected, including 431 male and 499 female. Meta-analysis showed that the incidence of postoperative bile leakage in patients with preoperative albumin (ALB) level of <35 g/L was significantly higher than that in their counterparts with preoperative ALB level of ≥35 g/L (OR=2.23, 95%CI: 1.16-4.28). The incidence of postoperative bile leakage in patients with common bile duct incision length of <1.5 cm during operation was significantly lower than that in those with a length of ≥1.5 cm (OR=0.42, 95%CI: 0.20-0.87). The incidence of postoperative bile leakage in patients receiving continuous suture of common bile duct was significantly lower than that in those treated with interrupted suture (OR=0.51, 95%CI: 0.29-0.90). The incidence of postoperative bile leakage in patients with common bile duct diameter of <1 cm was significantly higher than that in their counterparts with common bile duct diameter of ≥1 cm (OR=4.00, 95%CI: 2.23-7.17).

Selecting patients with common bile duct diameter of <1 cm, correcting ALB level before operation, maintaining the common bile duct incision length of within 1.5 cm during operation and adopting continuous suture can effectively reduce the risk of bile leakage after primary suture of LCBDE.