Seven RCTs were included in the review (n=554 patients). Trial quality was considered to be moderate to high (scores ranged from 5 to 10). Clinical heterogeneity with regard to trial population and surgical management was reported.
When clamp-crushing was compared with any alternative technique, no significant difference in overall morbidity was found (relative risk 0.89, 95% CI: 0.63, 1.25, six RCTs, n=504 patients). No evidence of significant statistical heterogeneity was found. When stratified by transection technique, clamp-crushing was found to be associated with fewer complications compared with radio-assisted transection (relative risk 0.15, 95% CI: 0.04, 0.62, one RCT, n=50 patients). No other subgroup analysis demonstrated a statistically significant difference in overall morbidity between treatment groups.
No significant differences were found for postoperative biliary leakage, transfusion rates or mortality when clamp-crushing was compared with any alternative technique. Subgroup analysis showed lower transfusion rates with clamp-crushing compared with water-jet dissector (relative risk 0.13, 95 CI: 0.02, 0.93, one RCT). No statistically significant between group differences were found for postoperative biliary leakage, or mortality.
Funnel plots for overall morbidity did not indicate publication bias.