To analyze the influencing factors of bile fistula after laparoscopic cholecystectomy (LC) and to construct a risk prediction model.

24 patients who underwent LC and developed bile fistula within 30 days after surgery were included in the bile fistula group; another 122 patients who underwent LC and did not develop bile fistula during the follow-up period were included in the non-bile fistula group. Multivariate Logistic regression analysis was used to analyze the influencing factors of bile fistula. A nomogram model was constructed, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the nomogram model for bile fistula after LC.

The patients in the bile fistula group had a higher prevalence of smoking history, hypertension history, diabetes history, ASA-PS grade III-IV, gallbladder wall thickness ≥ 5 mm, local anatomical variation, gallbladder and surrounding organ adhesion, and Calot triangle adhesion compared with the non-bile fistula group (P<0.05). Multivariate Logistic regression analysis showed that ASA-PS grade III-IV (OR=3.025, 95% CI: 1.985-4.611), local anatomical variation (OR=2.784, 95% CI: 1.487-5.213), gallbladder wall thickness ≥ 5mm (OR=2.550, 95% CI: 1.517-4.286), Calot triangle adhesion (OR=3.089, 95% CI: 1.364-6.996), and gallbladder and surrounding organ adhesion (OR=2.835, 95% CI: 1.470-5.466) were risk factors for bile fistula after LC (P<0.05). The nomogram model showed a consistency index (C-index) of 0.862 (95% CI: 0.810-0.913). The area under the curve (AUC) of the nomogram model for predicting bile fistula after LC was 0.876 (95% CI: 0.828-0.921), with a specificity of 67.1% and a sensitivity of 93.2%.

The risk factors for bile fistula after LC include local anatomical variation, gallbladder wall thickness, ASA-PS grade, Calot triangle adhesion, and gallbladder and surrounding organ adhesion. The constructed nomogram model has a high predictive value for bile fistula after LC.