Complication Of Cholecystectomy Research Articles

Осложнения лапароскопической холецистэктомии

Осложнения лапароскопической холецистэктомии

Treatment and prevention of complications of laparoscopic cholecystectomy

Objective To study causes,treatment and prevention of complications of laparoscopic cholecystectomy.Method Clinical data of 10 patients with complications after laparoscopic cholecystectomy was analyzed retrospectively.Results In 10 cases,there were 5 cases of bleeding during operation,1 case of bile duct injury,2 cases of postoperative bile leak,1 case of infection of incision,1 case of residual stone.Conclusions It can effectively decrease the incidence of complications of laparoscopic cholecystectomy to perform surgery indications strictly,reasonable operation skill,standard manipulation,be familiar with anatomic variation of ductus cysticus and blood vessel,and resolutely transfer laparotomy in time. Key words: Laparoscope; Cholecystectomy; Complication

A New Strategy of Minimally Invasive Surgery for Cholecystolithiasis: Calculi Removal and Gallbladder Preservation

Background: Cholecystolithiasis is a common disease. Cholecystectomy is the main treatment method but is associated with various complications in some patients. This study explores a novel, minimally invasive surgery for the removal of calculi and the preservation of the gallbladder using a laparoscope combined with the soft choledochoscope. Method: A retrospective analysis was conducted between January 2010 and December 2012 in 65 patients with cholecystolithiasis who underwent the minimally invasive surgery for calculi removal and gallbladder preservation. Results: In 61 cases of gallstone removal, the gallbladder was preserved perfectly with no complications. The other 4 cases were switched to laparoscopic cholecystectomy because of tiny stones blocking the cystic duct or submucosal stones. The success rate was 93.8%. Follow-up included both clinical assessment and ultrasound examination every 6 months after the operation. The patients with preoperative symptoms were symptom-free, and gallbladder function was well preserved. The overall stone recurrence rate was 4.92% at a mean follow-up of 26 months (range 6-40). Conclusions: Using the laparoscope combined with the soft choledochoscope for gallbladder-preserving cholecystolithotomy can remove stones, preserve gallbladder function, and effectively avoid the various complications of cholecystectomy. In our follow-up, gallbladder function was not affected and the stone recurrence rate was quite low.

Postoperative Delayed Duodenum Perforation following Elective Laparoscopic Cholecystectomy.

Background. Duodenum injury is extremely rare complication of laparoscopic cholecystectomy with potentially fatal consequences. Methods. Over the past 13-year period, 3000 laparoscopic cholecystectomies were performed in our institution. Duodenum injury only occurred in one patient recently who had undergone gastrectomy owing to duodenal diverticulum. The diagnosis and management of this rare complication of laparoscopic cholecystectomy are described, and the literature is reviewed. Results. We present this case of duodenum injury on the fourth postoperative day after selective laparoscopic cholecystectomy was treated successfully by percutaneous needle aspiration and catheter drainage. The hospital stay was 26 days. No abscess recurred during the follow-up period. Conclusion. Duodenum injuries are extremely rare complications of laparoscopic cholecystectomy with potentially fatal consequences if not promptly recognized and treated. Sonographically guided percutaneous needle aspiration and catheter drainage can be used to treat the intraperitoneal abscess. Billroth II subtotal gastrectomy and gastrojejunostomy were beneficial for the treatment.

Endoscopic management of bile leakage after cholecystectomy: a single-center experience for 12 years.

Background/AimsBile leakage is an uncommon but serious complication of cholecystectomy. The aim of this study is to evaluate the efficacy of the endoscopic management of bile leakage after cholecystectomy.MethodsA total of 32 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP), because of bile leakage after cholecystectomy, from January 2000 to December 2012 were reviewed retrospectively. The clinical parameters, types of management, and procedure-related complications were documented.ResultsMost bile leakages presented as percutaneous bile drainage through a Hemovac (68.8%), followed by abdominal pain (18.8%). The sites of bile leaks were the cystic duct stump in 25 patients, intrahepatic ducts in four, liver beds in two, and the common bile duct in one. Biliary stenting with or without sphincterotomy was performed in 22 and eight patients, respectively. Of the four cases of bile leak combined with bile duct stricture, one patient had severe bile duct obstruction and the others had mild stricture. Concerning endoscopic modalities, endoscopic therapy for bile leak was successful in 30 patients (93.8%). Two patients developed transient post-ERCP pancreatitis, which was mild, and both recovered without clinical sequelae.ConclusionsThe endoscopic approach of ERCP should be considered a primary modality for the diagnosis and treatment of bile leakage after cholecystectomy.

Sub Diaphragmatic Abscess Following Laparoscopic Cholecystectomy: an Uncommon Event

In the current era of minimally invasive surgery, Laparoscopic Cholecystectomy has become the gold standard for the surgical management of symptomatic gallstones. However, with the increase in the number of laparoscopic operations performed, there has also been a noticeable increase in the number of complications specific to these procedures. Known complications of laparoscopic Cholecystectomy include bowel and vascular injury, injury of the bile duct and complications of retained stones, in less than 5% procedures performed. Spillage of bile and stones in the abdominal cavity has been reported in 15%-40% of procedures performed, but these are believed to be innocuous. We report a patient who suffered a thoraco abdominal complication in form of right sub diaphragmatic abscess, may be due to bile spillage, three weeks after initial operation.

Hepatectomy for liver abscess caused by stones spilled during laparoscopic cholecystectomy

An abdominal abscess caused by spilled stones is a serious complication of laparoscopic cholecystectomy that requires drainage or reoperation to remove the scattered stones. Herein, we report the case of a 50-year-old woman, who was on dialysis for renal failure. She underwent major hepatectomy for a liver abscess caused by stones spilled during laparoscopic cholecystectomy.

Complications of Daytime Elective Laparoscopic Cholecystectomies Performed by Surgeons Who Operated the Night Before

Complications of Daytime Elective Laparoscopic Cholecystectomies Performed by Surgeons Who Operated the Night Before

Hepatic subcapsular biloma: a rare complication of laparoscopic cholecystectomy.

The development of an intra-abdominal bile collection (biloma) is an infrequent complication of laparoscopic cholecystectomy (LC). These bilomas develop in the subhepatic space most often secondary to iatrogenic injury of the extrahepatic ducts. We present a case of hepatic subcapsular biloma following LC and we discuss its etiology and management. Early diagnosis is crucial and percutaneous drainage under CT guidance should be employed to resolve this complication.

Meta-analysis of drainage versus no drainage after laparoscopic cholecystectomy.

Background and Objectives:Routine drainage after laparoscopic cholecystectomy is still controversial. This meta-analysis was performed to assess the role of drains in reducing complications in laparoscopic cholecystectomy.Methods:An electronic search of Medline, Science Citation Index Expanded, Scopus, and the Cochrane Library database from January 1990 to June 2013 was performed to identify randomized clinical trials that compare prophylactic drainage with no drainage in laparoscopic cholecystectomy. The odds ratio for qualitative variables and standardized mean difference for continuous variables were calculated.Results:Twelve randomized controlled trials were included in the meta-analysis, involving 1939 patients randomized to a drain (960) versus no drain (979). The morbidity rate was lower in the no drain group (odds ratio, 1.97; 95% confidence interval, 1.26 to 3.10; P = .003). The wound infection rate was lower in the no drain group (odds ratio, 2.35; 95% confidence interval, 1.22 to 4.51; P = .01). Abdominal pain 24 hours after surgery was less severe in the no drain group (standardized mean difference, 2.30; 95% confidence interval, 1.27 to 3.34; P < .0001). No significant difference was present with respect to the presence and quantity of subhepatic fluid collection, shoulder tip pain, parenteral ketorolac consumption, nausea, vomiting, and hospital stay.Conclusion:This study was unable to prove that drains were useful in reducing complications in laparoscopic cholecystectomy.

The crucial role of biliary endoscopists in the management of bile leak after cholecystectomy.

The crucial role of biliary endoscopists in the management of bile leak after cholecystectomy.

The problem with an Hepatic Artery Injury Postlaparoscopic Cholecystectomy in China

The incidence of vascular injury remains a problematic complication of laparoscopic cholecystectomy, due to the anatomic variations of the cystic artery. Therefore, the focus of this study was to investigate the origin, course, and termination of the cystic artery using dual source computed tomography. Currently, laparoscopic cholecystectomy (LC) has emerged as a golden standard in the treatment of cholelithiasis. A hepatic artery remains a problematic complication of laparoscopic cholecystectomy. The diversity of the anatomical variations of the cystic artery increases the risk of injury during LC, particularly in the presence of acute inflammation. It has been reported that a hepatic artery during laparoscopic cholecystectomy mainly occur during inadvertent procedure. Its incidence after cholecystectomy has been estimated to be 8% in an autopsy series of cadavers who had undergone laparoscopic cholecystectomy in China. This incidence seems increased in patients with a bile duct injury, ranging between 14% and 29%. As angiographic studies are usually not routinely performed, the exact figure is however unknown. It has been proposed that the presence of a hepatic artery may result in several complications including liver necrosis or abscess, increase the risk of bleeding at the time of the biliary repair, and favor recurrent stenosis. The development of multi-detector row CT has made it possible to clearly depict the cystic artery. Takahashi S et al.1 found that four–detector row CT made the hepatic artery more visible, including cystic artery. Sugita R et al.2 addressed the course of the cystic artery regarding the relationship to the Calot triangle with 64–detector row CT. In their study, they also reported the relationship between the cystic arteries and the Calot triangle and information on the anatomy of the cystic duct. Stewart L et al.3 published a discussion of the mechanisms to the right hepatic artery injury according to Stewart-Way classification. It is likely that the reason why the RHA injury lied on that is because the right hepatic artery is often mistaken for cystic artery (Stewart-Way class IV) (64%). But why the right hepatic artery mistaken for cystic artery is still not clear. Future research in China should focus on the anatomical details of the cystic artery and adjacent structures using dual source computed tomography (CT).

Insufficient safety measures reported in operation notes of complicated laparoscopic cholecystectomies

In 2007, a Dutch guideline for laparoscopic cholecystectomy (LC) was composed that advocates the critical view of safety (CVS) to prevent bile duct injury (BDI). Conversion to open cholecystectomy is recommended in complicated cholecystectomy, but young surgeons are hardly trained in this procedure. The aim of this study was to analyze the accuracy of dictated operation notes, the use of CVS before and after guideline implementation, and the severity of injury after conversion. Between 1990 and 2012, 800 patients were referred for treatment of BDI. All available operation notes (n = 528; 66%) were scored for procedural conditions, reasons for conversion, the use of safety measures, and postoperative care in BDI patients. Patient demographics, indication for cholecystectomy, conversion rates, and injury type were comparable to the total cohort of BDI patients. LC (n = 479; 91%) was converted in 180 patients (34%). The CVS technique or dissection of Calot's triangle were reported in 33 patients (6.3%) and 87 patients (16.5%), respectively. Guideline implementation increased the reporting of CVS from 4% (16/425) to 17% (17/103; P < .001), and the consultation of a hepatic-pancreatic-biliary (HPB) colleague from 3% (14/425) to 8% (8/103; P < .01). Conversion to open surgery leads to more complex injury (Bismuth III-V injury rate of 34% [24/64] vs 65% [46/116]; P = .013). The insufficient use of safety measures to prevent BDI during LC in this selected patient group is of concern. Although guideline implementation significantly improved the use of CVS during LC, further improvement is necessary. Conversion cannot simply be used as an "escape" procedure, because this may lead to more complex injury.

Thoracic Gallstones: A Delayed Complication of Laparoscopic Cholecystectomy

Thoracic complications resulting from gallstone spillage during laparoscopic cholecystectomy are rare and may occur years after the index surgery. We present the case of a chronic lung abscess resulting from trans-diaphragmatic migration of gallstones spilled and "lost" during a laparoscopic cholecystectomy. Case report and literature review. A 66-year-old female who had undergone a laparoscopic cholecystectomy 5 y previously presented with hemoptysis and was found to have a chronic lung abscess caused by "lost" gallstones. Her symptoms resolved with video-assisted thorascopic surgery, pulmonary decortication, and wedge resection. Thoracic complications from "lost" gallstones following laparoscopic cholecystectomy include empyema, hemoptysis, and cholelithoptysis. These rare complications sometimes require surgery but not all presentations of thoracic gallstones mandate operative intervention. Because of these potential complications of "lost" gallstones, reasonable efforts should be made to retrieve gallstones spilled during cholecystectomy. Persistent pulmonary symptoms following laparoscopic cholecystectomy mandate further radiologic examination and a review of the patient's operative report for "lost" gallstones.

Complications of Pediatric Cholecystectomy: Impact from Hospital Experience and Use of Cholangiography

Complications after cholecystectomy in children are poorly characterized. The aim of this study was to assess risk factors for major surgical complications for children undergoing cholecystectomy. All children 4 to 18 years old with gallbladder disease who underwent cholecystectomy from 1999 to 2006 were identified from the California Patient Discharge Database. Patient, hospital, and surgical factors were analyzed using multivariate logistic regression analysis to identify factors predictive of bile duct injury (BDI) and postoperative ERCP. A cohort of 6,931 children treated at 360 hospitals was evaluated. Most children underwent cholecystectomy at a non-children's hospital (84%). Intraoperative cholangiogram (IOC) was performed in 2,053 (30%) children. Of 5,101 children tracked through the year after cholecystectomy, 153 (3%) required readmission for surgical complications. Bile duct injury occurred in 25 (0.36%) children, and postoperative ERCP was performed in 711 (10%) children. Older age (odds ratio = 0.80; 99% CI, 0.67-0.95) was associated with decreased risk of BDI. Increased hospital tendency for routine IOC use was associated with increased likelihood of BDI (odds ratio = 12.92; 99% CI, 1.31-127.15). Receiving surgical care at a children's hospital was associated with a decreased likelihood of postoperative ERCP (odds ratio = 0.39; 99% CI, 0.23-0.66). As anticipated, choledocholithiasis, cholecystitis, IOC, and laparoscopic cholecystectomy were associated with increased risk of postoperative ERCP (p < 0.01). Serious complications and readmissions from pediatric cholecystectomy are uncommon. Surgeons performing cholecystectomy in young children must have an elevated concern about BDI. Routine IOC or surgical volume might not be helpful in lowering BDI rates.

Hepatic Actinomycotic Abscess With Pleural Effusion as a Complication of Cholecystectomy

Hepatic Actinomycotic Abscess With Pleural Effusion as a Complication of Cholecystectomy

Spigelian Port-site Hernia, a Complication after Laparoscopic Cholecystectomy - a Clinical Case Report

AbstractIntroduction: Spiegelian hernias are rare entities in abdominal wall pathology (2%). They occur in the semilunar line described by Adriaan van den Spiegel. Klinklosch (1764) defined it as a congenital or acquired defect of the transverse abdominal aponeurosis junction with the Douglas arch. Port-site hernias due to wrong placement of laparoscopic trocars in the right abdominal flank are rare, but possible complications of laparoscopic cholecystectomy. Case presentation: Our observation shows diagnostic and therapeutic aspects in a patient with port-site Spigelian hernia post laparoscopic cholecystectomy admitted in Surgical Clinic 1, County Emergency Clinical Hospital Tîrgu Mureș in the 28.01.2013 - 30.01.2013 period. Following surgery performed using an open approach, postoperative evolution was favorable, with no signs of recurrence at 9 months postoperatively. Conclusions: Spigelian port-site hernia post laparoscopic cholecystectomy is a very rare entity, iatrogeny being a certainty in its development

Detection and treatment of an aneurysma spurium of the arteria hepatica dextra after laparoscopic cholecystectomy

BackgroundMassive upper gastrointestinal hemorrhage can be the dominant symptom of decompensated liver cirrhosis, varices and ulcerations in the upper gastrointestinal tract. Postoperative complications are known to lead to these bleedings. Commonly, emergency endoscopy will be performed. Here we report of a patient with extensive bleeding caused by an aneurysma spurium of the arteria hepatica dextra induced by a laparoscopic cholecystectomy. The condition was diagnosed by the Doppler ultrasound scan of the liver.Case presentationInitially the source of the gastrointestinal bleeding was caused by an ulcus Dieulafoy in the jejunum which was stopped by clipping. Continous bleeding was observed and traced to a rare complication of a laparoscopic cholecystectomy due to a gallbladder empyema. After surgical intervention the patient developed an aneurysma spurium of the arteria hepatica dextra which was in communication with the small bowel. The successful treatment was performed by embolizing the aneurysma.ConclusionThe reasons for gastrointestinal bleedings are manifold. This case presents a seldom cause of a gastrointestinal bleeding due to an aneurysma of the hepatic arteria. The successful embolization was performed to ultimately stop the bleeding.

Progressive balloon dilatation following hepaticojejunostomy improves outcome of bile duct stricture after iatrogenic biliary injury

BackgroundIatrogenic biliary stricture (IBS) is a disastrous complication of cholecystectomy. Although the endoscopic treatments are well accepted as initial attempts for IBS, surgical hepaticojejunostomy (HJ) is often necessary for a considerable proportion of patients. However, the anastomotic stricture after HJ also occurs.MethodsIn the present study, a new procedure, progressive balloon dilation following HJ (HJPBD), was designed and utilized in the IBS treatment. We retrospectively compared HJPBD with the traditional HJ in term of the outcomes when used for IBS treatment.ResultsBetween January 1997 and December 2009, 112 patients with IBS attributed to cholecystectomy enrolled in our hospital were treated with surgical reconstruction with either HJ (n=58) or HJPBD (n=54). Of the 58 patients in HJ group, 48 patients (82.8%) had a successful outcome, while 52 out of 54 patients (96.3%) in HJPBD group achieved success. The successful surgical reconstruction rates were significantly different between these two groups, with a further improved outcome in patient undergone progressive balloon dilation following HJ. Additionally, 8 of the 10 failure cases in HJ group were successfully rescued by HJPBD procedure.ConclusionsOur findings suggest that the new procedure of HJPBD could be successfully applied to IBS patients, and significantly improve the outcome of IBS reconstruction.

Intraoperative Management and Repair of Bile Duct Injuries Sustained during 10,123 Laparoscopic Cholecystectomies in a High-Volume Referral Center

Bile duct injury (BDI) remains the most serious complication of laparoscopic cholecystectomy (LC). The best strategy in terms of timing of repair is still controversial. The purpose of the current study is to review the experience in the intraoperative repair of bile duct injuries sustained during LC at a high-volume referral center. Single-institution retrospective analysis of a prospectively collected database. Patients with diagnosis of BDI sustained during LC between October 1991 and November 2010 were extracted. Among 10,123 LC performed during the study period, 19 patients had a BDI sustained during the procedure. Intraoperative cholangiography was routinely used. Bile duct injury was diagnosed intraoperatively in 17 patients (89.4%). Mean age was 56.4 years (range 18 to 81 years) and 15 patients were women (88%). According to the Strasberg classification of BDI, there were 3 type C lesions, 12 type D lesions, and 2 type E2 lesions. There were no associated vascular injuries. Twelve cases (71%) were converted to open surgery. The repairs included 10 primary biliary closures, 4 Roux-en-Y hepaticojejunostomies, 2 end to end anastomosis, and 1 laparoscopic transpapillary drainage. Postoperative complications occurred in 5 patients (29.4%). During the follow-up period, early biliary strictures developed in 2 patients (11.7%) and were treated by percutaneous dilation and a Roux-en-Y hepaticojejunostomy with satisfactory long-term results. The current series represents one of the largest single-center experiences in terms of intraoperative repair of BDI sustained during LC. The results suggest that a high level of intraoperative diagnosis is possible, where intraoperative cholangiography is a useful tool. The intraoperative repair of BDI sustained during LC by experienced hepatobiliary surgeons either by open or laparoscopic approach appears of paramount importance to assure optimal results.