Complication Of Cholecystectomy Research Articles

Complications of Laproscopic Cholecystectomy in Patients of Acute Cholecystitis

Objective: To determine the complications of laparoscopic cholecystectomy in patients of acute cholecystitis. Study Design: Prospective study. Place & Duration: Department of Surgery, Lady Reading Hospital, Peshawar for duration of six months from January 2020 to June 2020. Methods: Total 120 patients of both genders with ages 20 to 60 years were included in this study. Patients’ detailed demographics were recorded after taking written consent. Patients with history of abdominal surgery were excluded. All the patients underwent laparoscopic cholecystectomy for gall bladder diseases. Post-operative pain was analyzed by VAS. Complications were recorded at 5th postoperative day. Data was analyzed by SPSS 24.0. Results: Out of 120 patients 30 (25%) patients were males and 75% patients were females. Most of the patients 50 (41.67%) were in the age group 31 to 40 years followed by 37 (30.83%) patients were ages between 41 to 50 years. 70 (58.33%) patients had surgical size port incision was 5mm and 50 (41.67%) patients had 10mm. Mean pain score was 2.24+1.1 at 5th postoperative day. Wound infection was found in 10 (8.33%). Port site hernia was found in 12 (10%). Conclusion: Laparoscopic cholecystectomy is safe and effective treatment procedure with no major complications. Keywords: Laparoscopic Cholecystectomy, Acute Cholecystitis, Wound Infection, Port Site Hernia, Pain

Optimal timing of cholecystectomy after necrotising biliary pancreatitis

ObjectiveFollowing an episode of acute biliary pancreatitis, cholecystectomy is advised to prevent recurrent biliary events. There is limited evidence regarding the optimal timing and safety of cholecystectomy in patients with...

Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

BackgroundHemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation.Case presentationA 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient’s vital signs were stable, and there was no sign of rebleeding.ConclusionGastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.

Bile leakage from subvesical bile duct (duct of Luschka) after laparoscopic cholecystectomy

Bile leakage is a serious complication in laparoscopic cholecystectomy. Subvesical bile duct (duct of Luschka) injury is a secondary major cause of bile duct injury after laparoscopic cholecystectomy. Between January 2019 and December 2020, we performed 1,269 laparoscopic cholecystectomies in our department. There were 4 cases (0.3%) of subvesical bile duct injury. 1 case was found during operation, the other 3 cases developed abdominal pain after postoperative 3th or 7th days. In the intra-operative case, the injured duct was closed with endo-clip. There was no post-operative complication. Postoperatively found cases were treated with endoscopic retrograde cholagiopanreatography (ERCP). However, ERCP failed (2), continuous bile leak and abdominal pain (1) developed. Re-laparoscopy (2) and explo-laparotomy (1) performed. During operation, meticulous observation of the gallbladder fossa should be performed after cholecystectomy. If bile leak has found post-operatively, ERCP with biliary stenting is effective. If ERCP fails, surgical treatments required. A surgeon should be aware of this anomaly of the bile duct and know about the prevention and the managements.

Early complications of laparoscopic cholecystectomy

The gallbladder stones as worldwide disease occurs in 10% of the world population. After laparoscopic cholecystectomy (LCE) complications observed at 1% to 8.5%. The aim is to evaluate the early postoperative complications (EPC) of LCE in our medical center. Analyzed 983 LCE, which performed in period 2014 to 2020 in "Aktobe Medical Center". Of these 598 patients (60.9%) had GS with acute cholecystitis, 385 (39.1%) - chronic cholecystitis. Woman - 74.2% (n = 729), man - 25.8% (n = 254). EPC was in 24 (2.4%) patients. Cause of EPC were: bile leakage - in 7 patients (29.2%) (in 2 patients it is stopped on their own), bleeding - 4 (16.7%), sub-hepatic infiltrate - 3 (12.5%), choleperitonitis after extrahepatic bile duct injure - 2 (8.3%), abdominal wall wound inflammatory complications - 8 (33.3%). Nine patients were undergoing reoperation in early postoperative period. Seven patients had relaparoscopy due to bile leakage from the cystic duct stump (2 cases) and from Luschka duct (3 cases); bleeding from cystic artery (2 cases). Reasons of early 2 laparotomies were bile leakage with choleperitonites after extrahepatic bile duct injure. In three cases with bile leakage we held suturing the bile ducts wall. Umbilical wound inflammatory complications resolved conservatively. One patient died after pulmonary artery thromboembolism - 0.1%. Our analysis indicates that LCE has a low number of complications and minimal mortality. However, there are serious injuries to the bile ducts, which can be minimized by improving surgical techniques.

Evaluation of the Bleeding Complications in Laparoscopic Cholecystectomy in a Tertiary Care Hospital: A Cross-Sectional Study

Objective: To determine the frequency of various sources of bleeding in laparoscopic cholecystectomy with special preference to gallbladder bed excluding port site.
 Methods: This cross-sectional study was consisted of 163 patients admitted through the outpatient department from Peoples Medical College Hospital Nawabshah. Ultrasound of abdomen was done as diagnostic modality and for assessment of gallstone disease. Finally the cases of gallstone were operated through laparoscopic cholecystectomy procedure and observed for sources of bleeding.
 Results: Out of 163 patients included in this study 138(84.7%) were female and 25(15.3%) patients were male; with female to male ratio of 5.52:1. The mean age was 41.85±7.83 years. Common sources of bleeding in laparoscopic cholecystectomy from liver bed side were 44(27%) cases followed by cystic artery in 17(10.4%) cases, hepatic artery and mesenteric vessel in 1(0.6%) case was observed.
 Conclusion: Bleeding during laparoscopic cholecystectomy are almost equally common and can prove to be lethal if not identified and managed during the operation. Good surgical technique, awareness and early recognition and management of such cases are keys to success when dealing with this problem.

BILE DUCT INJURY IN LAPAROSCOPIC CHOLECYSTECTOMY: DIAGNOSIS AND MANAGEMENT

Laparoscopic cholecystectomy becomes standard technique for management symptomatic cholelithiasis, polype. The risk of bile duct injury following laparoscopic cholecystectomy is higher than open cholecystectomy. Purpose: To diagnosis the type of injury bile duct and management bile duct injuries sustained by laparoscopic cholecystectomy. Patients and Methods: Retrospective analyses of the patients undergoing laparoscopic cholecystectomy from 01/1999 to 06/2020. We evaluated the data according to outcome measures, characteristics and treatment results of major bile duct injuries after laparoscopic cholecystectomy. Results: We found 21 patients with major bile duct injuries sustained by laparoscopic cholecystectomy. Only 23.8% of injuries are recognized during operation. Type of injuries include: Lateral injury of common bilde duct were 4 cases, transection of bile duct were 4 cases. Management injuries include: bile duct suture were 4 cases (19.1%), hepaticojejunostomy were 10 cases (47.6%), choledochojejunostomy were 6 cases (28.5%). Conclusion: Common bile duct injury is a rare complication of laparoscopic cholecystectomy (0.35%). Immediate recognition and repair are associated with improved outcome. The optimal management depends on the timing of recognition of injury, the type, extent of bile duct injury, the patient’s conditions and the availability of experienced hepatobiliary surgeons.

A COMPARATIVE STUDY TO ASSESS THE NEED OF PROPHYLACTIC ANTIBIOTICS IN EARLY INFECTIVE COMPLICATIONS OF LOW RISK ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY

Background And Objectives: Elective laparoscopic cholecystectomy has a low risk for infectious complications, but many surgeons still use prophylactic antibiotics. The aim of this study was to investigate the necessity and rationale for giving prophylactic antibiotics in early infective complications in low-risk laparoscopic cholecystectomy. Study Design: Low-risk patients were randomly placed into 2 groups: 70 patients (group A ) did not receive any prophylactic antibiotic and 70 patients (group B) received 1 g Ceftriaxone intravenously at the time of induction of anaesthesia. In both groups, incidence of infective complications were recorded and compared. Results: In group A, there were 3 cases of post operative fever and 1 case of wound infection, while there were no cases of pulmonary infections and urinary tract infection. In group B, there were 2 cases of post operative fever and 1 case of wound infection, while there were no case of pulmonary infections and urinary tract infection. No signicant difference existed in the incidence of complications between the groups. Prolonged duration of surgery and Bile or Stone spillage were statistically signicant risk factors in determining post operative infective complications. Conclusions: Use of prophylactic antibiotic does not affect the already low incidence of postoperative infective complications and surgical site infections. Hence, prophylactic antibiotic is not necessary in low-risk elective laparoscopic cholecystectomy

The complications of subtotal cholecystectomy: A case report.

IntroductionAlthough the symptoms attributed to gall stones resolve in most patients after cholecystectomy, some may have symptoms that persist or recur. It is known as the post-cholecystectomy syndrome (PCS). The aim of this case was to describe the diagnostic difficulties encountered and to discuss the main etiologies of this entity.Case reportA 54-year-old man presented for a recurrent right upper quadrant pain despite laparoscopic cholecystectomy five years ago. Imaging showed cystic lesion at the gallbladder fossa with gallstones. We decided to reoperate the patient by laparoscopic approach. It turned to be a residual gallbladder with stones inside. It was confirmed by histopathology. He was asymptomatic after a follow-up of 2 years.DiscussionThe PCS should not be trivialized. Most of the causes are allocated to extra biliary etiologies. They must be ruled out first as most of them can be controlled with medication. There are etiologies for which re-operation can be necessary.ConclusionThe indication of cholecystectomy must be taken wisely otherwise surgery will not solve the problem. Even though patient may complain of persistence or recurrence of the pain. In this case, it can be a real challenge for both diagnosis and treatment.

The Efficacy of Intraoperative Fluorescent Imaging Using Indocyanine Green for Cholangiography During Cholecystectomy and Hepatectomy.

PurposeBile duct injury is one of the most serious complications of laparoscopic cholecystectomy. Intraoperative indocyanine green (ICG) cholangiography is a safe and useful navigation modality for confirming the biliary anatomy. ICG cholangiography is expected to be a routine method for helping avoid bile duct injuries.Patients and MethodsWe examined 25 patients who underwent intraoperative cholangiography using ICG fluorescence. Two methods of ICG injection are used: intrabiliary injection (percutaneous transhepatic gallbladder drainage [PTGBD], gallbladder [GB] puncture and endoscopic nasobiliary drainage [ENBD]) at a dosage of 0.025 mg during the operation or intravenous injection with 2.5 mg ICG preoperatively.ResultsThere were 24 patients who underwent laparoscopic cholecystectomy and 1 patient who underwent hepatectomy. For laparoscopic cholecystectomy, the average operation time was 127 (50–197) minutes, and estimated blood loss was 43.2 (0–400) g. The ICG administration route was intravenous injections in 12 cases and intrabiliary injection in 12 cases (GB injection: 3 cases, PTGBD: 8 cases, ENBD:1 case). The course of the biliary tree was able to be confirmed in all cases that received direct injection into the biliary tract, whereas bile structures were recognizable in only 10 cases (83.3%) with intravenous injection. The postoperative hospital stay was 4.6 (3–9) days, and no postoperative complications (Clavien–Dindo ≧IIIa) were observed. For hepatectomy, a tumor located near the left Glissonian pedicle was resected using a fluorescence image guide. Biliary structures were fluorescent without injury after resecting the tumor. No adverse events due to ICG administration were observed, and the procedure was able to be performed safely.ConclusionICG fluorescence imaging allows surgeons to visualize the course of the biliary tree in real time during cholecystectomy and hepatectomy. This is considered essential for hepatobiliary surgery to prevent biliary tree injury and ensure safe surgery.

MRI evaluation of bile duct injuries and other post-cholecystectomy complications.

Laparoscopic cholecystectomy is one of the most common procedures performed each year and can be associated with various post-operative complications. Imaging is integral to diagnosis and management of patients with suspected cholecystectomy complications, and a thorough understanding of normal and abnormal biliary anatomy, risk factors for biliary injury, and the spectrum of adverse events is crucial for interpretation of imaging studies. Magnetic resonance cholangiography (MRC) enhanced with hepatobiliary contrast agent is useful in delineating biliary anatomy and pathology following cholecystectomy. In this article, we provide a protocol for contrast-enhanced MR imaging of the biliary tree. We also review the classification and imaging manifestations of post-cholecystectomy bile duct injuries in addition to other complications such as bilomas, retained/dropped gallstones, and vascular injuries.

Why are we still using antibiotic prophylaxis in elective laparoscopic cholecystectomy for the low-risk groups? a review of literature

Gallstone disease is one of the most common gastrointestinal conditions requiring surgery and more than 90% of cholecystectomies are done laparoscopically. The major complications of laparoscopic cholecystectomy are major bleeding, Bile duct injury, and wound infection or surgical site infection. The incidence of Surgical site infection in laparoscopic cholecystectomy (0.4-1.13%) is significantly low compared to open cholecystectomy (3-47%) and the probable reasons are the smaller incision and the use of trocar along with almost nil to minimal wound contamination as compared to open cholecystectomy. Port site infection is a type of surgical site infection (1.8%) and the Umbilical port site is the most common site followed by the epigastric port site. In spite of the low-risk of surgical site infection, many surgeons still practice antibiotic prophylaxis in elective laparoscopic cholecystectomy for low-risk patients. Antibiotic prophylaxis is a debatable topic in the low-risk group undergoing elective laparoscopic cholecystectomy.Meticulous preoperative skin preparation is one of the established local factors to prevent the occurrence of SSI.

A rare case of atypical accessory bile duct: Luschka

A 56-year-old male patient was admitted to our hospital with indigestion and abdominal bloating after eating. During routine surgery, a cystic artery, cystic duct, and an additional second duct were detected in the area of the Calot’s triangle. Considering that this channel is the accessory bile duct entering the gallbladder during dissection, this structure, cystic duct and cystic artery were double clipped and cholecystectomy was completed. Bile duct injury is a serious complication of laparoscopic cholecystectomy (LC). Bile leakage from accessory duct of Luschka is very rare. Anomalies of the bile ducts are common due to complex embryological stages of development. We wanted to share the presence of the atypical localized luschka canal that we encountered during gallbladder surgery. In our case, during the dissection of the Calot’s triangle, luschka was considered the main bile duct first, and after extensive dissection, it was concluded that this structure was luschka. During laparoscopic cholecystectomy operations, we recommend that the cystic artery and Canal be clipped after extensive dissection of the Calot’s triangle or even the hepatic triangle in experienced hands

Knowledge of the Culture of Safety in Cholecystectomy (COSIC) Among Surgical Residents: Do We Train Them Well For Future Practice?

Biliary injury is the most feared complication of laparoscopic cholecystectomy (LC). This study aimed to assess the awareness of culture of safety in cholecystectomy (COSIC) concept among the surgical residents in India. A manual survey was conducted among general surgery residents attending a postgraduate course. Survey consisted of questions pertaining to knowledge of various aspects of COSIC, e.g., the critical view of safety (CVS). With a response rate of 51%, 259 residents were included in this study. They had more exposure to LC (63.3% assisted / performed > 15 LC) than to open cholecystectomy (60.6% assisted / performed ≤ 10 open cholecystectomy). The majority (80.2%) clearly differentiated Calot triangle from the hepatocystic triangle (HCT). However, 25.8% could not correctly define HCT. Themajority (88.5%) had seen the Rouviere's sulcus during LC. While almost all (98.4%) respondents claimed to know about thesegment 4, only 41.9% could correctly describe it. Awareness of the correct direction of thegallbladder retraction was lower for the infundibulum (53.5%) than for fundus (89.2%). Themajority (88.3%) claimed to know CVS but only 11.5% knew it correctly, and 15.1% described > 3 components. Themajority (78.7%) practiced to identify thecystic duct-common bile duct junction. Awareness was low for time-out (28.1%), intraoperative cholangiography (20.6%), bailout techniques (18.9%), and for overall COSIC concept (15.7%). Knowledge of COSIC among surgical residents seems to be suboptimal, especially for theCVS, time-out, bailout techniques, and overall concept of COSIC. Strategies to educate them more effectively about COSIC are highly imperative to train them well for future practice.

Impact of laparoscopic cholecystectomy on the complexity of endoscopic retrograde cholangiopancreatography.

A scarce number of researches discussed the impact of cholecystectomies on the anatomy of common bile duct (CBD) and intern if this will affect the difficulty of endoscopic retrograde cholangiopancreatography (ERCP). The objective of present study was to assess the impact of complicated cholecystectomy on the complexity and safety of the ERCP procedure. A total of 100 patients were enrolled after meeting the following inclusion criteria - study group (group A): 50 patients with previous history of complicated laparoscopic cholecystectomy and control group (group B): 50 patients with previous noncomplicated laparoscopic cholecystectomy. ERCP was performed and complexity was judged by a number of cannulation attempts, ERCP time, pancreatic cannulation and post-ERCP pancreatitis. The study revealed prolonged ERCP procedure duration in noncomplicated cholecystectomy (24.2 ± 8.5 min) and it was significantly more prolonged in complicated cholecystectomy (39.6 ± 10.7 min; P = 0.03). The trials of cannulation attempts were significantly higher in the study group with complicated cholecystectomy (P = 0.009). Pancreatic duct cannulation was frequently higher in the complicated cholecystectomy group (P = 0.03). Difficult or failed stone extraction was significantly prevalent in the complicated cholecystectomy group and the occurrence of post-ERCP pancreatitis (PEP) was significantly higher than the control group. ERCP after complicated laparoscopic cholecystectomy is more complex with increased duration liability of complications.

Association between Socioeconomic Factors and Postoperative Complications of Cholecystectomy

The article´s goal isto determine if socioeconomic factors influence the postoperative complications of cholecystectomy. For this, the observational study was defined, analytical and quantitative study was conducted in 100 patients who underwent cholecystectomy. A logistic regression model was applied in which risk factors, socioeconomic characteristics, along with a control variable, were incorporated as variables. Three models were run with alternative dependent variables that are delimited by the type of postoperative complication recorded. The results found showed that women show a higher risk of presenting complications after cholecystectomy, the same occurs in older patients. Likewise, the risk is much lower in people with higher education levels and in patients who underwent laparoscopic cholecystectomy, they only have a 5% risk of presenting complications. Postoperative complications after cholecystectomy are minimized by using the laparoscopic technique and socioeconomic factors would influence the risk of suffering postoperative complications after said surgery, which makes laparoscopic cholecystectomy a safe operation with many other benefits and advantages over traditional or conventional surgery.

Safe Cholecystectomy Using an Indocyanine Green(ICG) Fluorescence Cholangiography during Laparoscopic Cholecystectomy

Introduction: Bile duct injuries are the most dismal complication in cholecystectomy. The Critical View of Safety (CVS) has been shown to be a good way to obtain the secure anatomical identification. We try to get an early detection of imaginatory dissection line (fig. 1.) for obtaining the CVS using an ICG fluorescence cholangiography during laparoscopic cholecystectomy

A retrospective assessment of the complications and associated risk factors of laparoscopic cholecystectomy

Aim: The aim of the present study to assess the risk factors and complications of Laparoscopic Cholecystectomy. Material and Methods: This was a retrospectively analysed study conducted in the Department of General Surgery, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Chhattisgarh, India, from December 2018 to November 2019. 100 patients who were diagnosed with cholelithiasis and had laparoscopic cholecystectomy were included in this study. We analysed the type and frequency of intraoperative and postoperative complications, as well as factors that increase the risk for development of complications. We noted causes and incidence of conversions and the way they resolved. We noted gender, age, body mass index (BMI), white blood cell count, and level of C-reactive protein (CRP), preoperative ultrasonographic findings, Patho histological findings of the surgically removed gallbladder, as well as their correlation with the occurrence of complications. Results: Out of the 100 patients in the study, 68 were female (68%), and 32 were male (32%). The most common complications noted were: iatrogenic perforations of the gallbladder- 5 (5%), bleeding from the tissues adjacent to the gallbladder 3 (3%), gallstones spilt into the peritoneal cavity 2 (2%). Intraoperative bleeding from the cystic artery occurred in 1 (1%), bleeding from the port in 1 (1%) and bleeding from the ligaments of the liver in 1 patients (1%). The transection of the common bile duct, a major complication, occurred in only one patient (1%). The most common postoperative complications were: bleeding from the abdominal cavity more than 100 ml/24h (in 3 patients or 3%), bile leaks through the drain > 50-100 ml/24h (2 patients, or 2%). In addition, the ultrasonographic findings of empyema, gangrene of the gallbladder wall, and increased gallbladder wall thickness > 3 mm (group II) is a significant predictor of complications and conversion (OR = 4.92, 95% CI 1.61-18.13, p< 0.001). Patho histologic analysis of the surgically extracted gallbladder with the diagnosis of acute cholecystitis was also the significant predictor for complications and conversion (OR 1.82, 95% CI 2.52-16.66, P< 0.001). Conclusion: the laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay.

Outcome of Laparoscopic Cholecystectomy by Exposing the Inner Layer of the Subserosal Layer

Introduction: Bile duct injury is the serious complication of laparoscopic cholecystectomy (LC). Therefore, the critical view of safety has been accepted as a safe method for gaining a sufficient view of Calot's triangle. However, it usually difficult to achieve a critical view of safety in presence of severe gallbladder inflammation due to a frozen Calot's triangle. Universal safe procedure of laparoscopic cholecystectomy by exposing the inner layer of the subserosal(SS) layer was introduced by G.Honda et al (2016).

Management of Type E Bile Duct Injuries over a 10 Year Period at a HPB Referral Unit

Introduction: Common Bile Duct Transection is an unfortunate rare complication of Laparoscopic Cholecystectomy. We reviewed management of Common Bile Duct transections (Type E injuries) during Laparoscopic Cholecystectomy over 10 year period at our Hospital, which is a HepatoPancreaticoBiliary referral centre for the area.