Impact of Intraoperative Biliary Spillage on Surgical Site Infection and Postoperative Outcomes After Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis.

Abstract

Intraoperative bile spillage during laparoscopic cholecystectomy (LC) is common, yet its impact on surgical site infection (SSI) and postoperative outcomes remains unclear. To evaluate the association between intraoperative bile spillage and SSI and to assess its impact on other postoperative outcomes, a systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. PubMed, Embase, Scopus, and Cochrane Central were searched for comparative studies evaluating outcomes in patients with and without intraoperative bile spillage. The primary outcome was SSI. Secondary outcomes included overall complications and hospital stay. Pooled effect estimates were calculated using a random-effects model and reported as odds ratios (ORs) with 95% confidence intervals. A total of 11 studies involving 51,642 patients were included. Intraoperative bile spillage was associated with a significantly increased risk of SSI (pooled OR indicating a modest but significant association), with moderate heterogeneity across studies. Bile spillage was also associated with prolonged hospital stay and higher overall complication rates. Subgroup analysis suggested that gallstone spillage and bacteriobilia may further increase the risk of infectious complications. Routine postoperative antibiotic use did not significantly reduce SSI rates following bile spillage. Intraoperative bile spillage during LC is associated with a modest increase in SSI risk and postoperative morbidity. The risk appears to be influenced by the presence of gallstones and bacteriobilia. Current evidence does not support routine postoperative antibiotic prophylaxis solely due to bile spillage.