Experience of management of severe complications after laparoscopic cholecystectomy in 22 patients

Abstract

Objective To explore the treatments of severe complications after laparoscopic cholecystectomy (LC). Methods Clinical data of 22 patients with severe complications after LC admitted to Kailuan General Hospital from September 2012 to November 2017 were retrospectively analyzed. Among them, 8 patients were male and 14 female, aged 47-88 years with a median age of 59 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The treatments of severe postoperative complications were summarized and analyzed. Results 3 cases suffered from hemorrhage after operation, 1 of them treated with emergent open hemostasis due to hepatic artery injury and 2 cases of gallbladder artery hemorrhage received interventional embolization. 6 cases developed bile leakage, 3 of them had abdominal drainage tube placed and received symptomatic treatments, such as immobilization, fasting and water deprivation, anti-inflammatory, and fluid infusion, 2 cases received emergent open drainage and 1 case underwent ultrasound-guided puncture drainage. 7 cases suffered from bile duct injury,1 of them had abdominal drainage tube placed, 4 cases had T tube placed through open surgery, 1 case underwent Roux-en-Y anastomosis and 1 case underwent repair of common bile duct. 6 cases suffered from postoperative choledocholithiasis. Among them, 1 case was treated with integrated therapy of traditional Chinese and western medicine, 2 cases underwent repeated laparoscopic surgery and 3 cases were treated with ERCP. After active and appropriate treatments, all patients were cured. Conclusions Explicit preoperative inquiry of medical history, well knowing the anatomical relations during operation, selecting the appropriate timing of open surgery and protecting the normal physiological channels are the key factors for well prognosis of patients with severe complications after LC. Key words: Cholecystectomy, laparoscopic; Postoperative complications; Prognosis