Management for Hemorrhage from the Gallbladder Bed Caused by Injury to the Middle Hepatic Vein During Laparoscopic Cholecystectomy

Abstract

Hemorrhage from the gallbladder bed during laparoscopic cholecystectomy which is a risk factor for conversion to laparotomy remains a serious problem. And injury to branches of the middle hepatic vein is an important reason for bleeding from the gallbladder fossa. The aim of this study was to report our experience of laparoscopic management for hemorrhage from the gallbladder bed because of injury to the middle hepatic vein. This study involved 8 patients with injury to the middle hepatic vein during laparoscopic cholecystectomy, and their records were analyzed retrospectively. Compression hemostasis with gauze was firstly performed to reduce or stop bleeding from the gallbladder bed in each patient. An injured branch of the middle hepatic vein in a patient was sutured with 3/0 non-absorbable suture under laparoscopy. The hemorrhage in the other 7 patients was managed successfully by closing the injured branches of the middle hepatic vein with laparoscopic Hem-o-lok tip. The mean time spent to maintain hemostasis was 27.6 min. LC was finished in each case. No patient received blood transfusion. Serious complications such as bile duct injury and hepatic artery bleeding did not occur during LC and after operation; there was no obvious abnormality in liver function after surgery. All of the 8 patients were cured and discharged, and no complication occurred after 12 months of follow-up. Laparoscopic treatment for hemorrhage caused by injury to the branches of the middle hepatic vein is safe and effective, and calm operation and maintaining a clear surgical vision is the premise of effective control for bleeding. Compression on the bleeding area of source with gauze is the first choice to stop bleeding during LC. But when the laparoscopic treatment for bleeding is difficult, it still should be timely converted to open surgery.