Complication Of Laparoscopic Cholecystectomy Research Articles

Comparison of outcome of male versus female laparoscopic cholecystectomy: BMI-adjusted prospective observational study

Background. Laparoscopic cholecystectomy has become the choice of treatment for symptomatic cholelithiasis and has replaced open cholecystectomy. Numerous studies and scoring system have been developed over the past 2–3 decades which predict the rate of conversion of laparoscopic to open cholecystectomy. Recently, few scoring systems have been developed which incorporates various intraoperative findings to predict this conversion. No studies are available in literature to assess gender-specific and body weight complications in laparoscopic cholecystectomy. The purpose of this study was to compare the outcome of laparoscopic cholecystectomy between male and female patients in terms of preoperative factors, intraoperative difficulties and rate of conversion to open cholecystectomy and common postoperative complications. Materials and methods. This non-randomized, prospective, observational study was conducted at a tertiary care hospital in Northern India from June 2019 to May 2021. Various preoperative data was collected from the patients like age, the American Society of Anesthesiologists (ASA) class, comorbidity, indication for surgery, preoperative ultrasonography findings and any previous surgery. Surgeries in all patients were started with laparoscopic cholecystectomy under general anaesthesia. The outcomes were measured in terms of time taken to complete surgery, whether laparoscopic cholecystectomy was converted to open cholecystectomy, common bile duct/cystic duct injury during surgery, common postoperative complications and average length of hospital stay in days. Results. A total of 300 patients were included in the study: 222 females and 78 males. Mean age of presentation in women was (46.45±11.55) years ranging from 21 to 71 years and in men (51.78±11.49) years ranging from 36 years to 76 years. This difference was statistically significant (p=0.001). The other significant preoperative differences between males and females were comorbidity (p=0.001) and previous surgeries (p=0.001). However, the ASA class under which the patients were operated was not significant (p=0.998). The various indications for surgery to include chronic cholecystitis, resolved acute cholecystitis, gallstone-induced pancreatitis and common bile duct stone had no statistical difference between men and women (p=0.072). Conclusions. This study concludes that intraoperative difficulties were more often in male patients as compared to females. The average operating time, conversion of laparoscopic to open cholecystectomy and postoperative hospital stay were significantly higher in men than in women.

Body-first approach of laparoscopic cholecystectomy for minimizing vasculobiliary injury: Initial experience.

Vasculobiliary injury (VBI) is a rare but critical complication of laparoscopic cholecystectomy (Lap-C). Dividing first the gallbladder body and then the gallbladder neck from the gallbladder bed (the "body-first approach") may decrease the possibility of VBI. The surgical outcome of 62 patients who underwent Lap-C with a body-first approach were evaluated. In this procedure, after serosal resection of the gallbladder, the gallbladder body is divided from the cystic plate; then the gallbladder neck and cystic duct are isolated. No connective tissue of the hepatic hilum is touched. A total of five patients had anatomical anomalies of the biliary tract that raised concerns of cholecystectomy. Furthermore, seven patients underwent subtotal cholecystectomy. No patients required conversion to open surgery, and none developed VBI or postoperative complications of Clavien-Dindo grade 3a or worse. The body-first approach may minimize the risk of VBI during Lap-C.

Complications in Laparoscopic Cholecystectomy: Experiences from A Study of 1425 Cases

Objective: To evaluate the complications of laparoscopic cholecystectomy in the symptomatic cholelithiasis and other benign gall bladder diseases. Methods: This descriptive observational study was carried out at CMH Dhaka and CMH Jashore from March 2016 to Jun 2022, to evaluate the frequency and outcome of management of all the complications in laparoscopic cholecystectomy. A total of 1425 patients of laparoscopic cholecystectomy were included in this study. Patients were followed up for a period of three months after operation. The complications in laparoscopic cholecystectomy observed in this study were divided into (i) Access related (ii) Intraoperative (biliary and extrabiliary) and (iii) Postoperative. Results: The incidence of access-related, intraoperative or procedure-related biliary, extrabiliary and postoperative complications were 3.64%, 2.95%, 4.98% and 1.96% respectively. Access related complications were extraperitoneal insufflations 1.40%, port site bleeding 1.19%, small bowel laceration 0.21% and transverse colon injury 0.07%.Procedural biliary complications included common bile duct (CBD) injury 0.14%, common hepatic duct (CHD) injury 0.07% and iatrogenic gall bladder perforation with bile leakage 2.74%. Procedural extrabiliary complications were Liver injury 0.56%, duodenal perforation 0.07%, colon perforation 0.07%, bleeding through cystic artery 0.49% and bleeding from gall bladder fossa 1.12%. Two colonic perforations and one duodenal perforation were the major complications encountered in this series. Two colonic perforations required conversion to open procedure but duodenal perforation was managed laparoscopically by intracorporeal suturing. Total nine (0.63%) patients required conversion to open procedure. Postoperative complications included port site infection (PSI) 1.05%, port site hernia 0.56%, major sepsis 0.14% and ischemic stroke 0.07%. There was no retained stone, biliary stricture and mortality reported in this series. Conclusion: Complications in laparoscopic cholecystectomy are mainly due to access related and intraoperative and have their own characteristics.. CBD transaction, CHD injury, Colonic perforations and duodenal perforations were the major complications requiring conversion to open procedure except duodenal perforation which was dealt laparoscopically. Conversion to open procedure should not be considered as a complication. J Bangladesh Coll Phys Surg 2023; 41: 75-81

Per-Operative and Post-Operative Complications of Laparoscopic Cholecystectomy: A Cross-Sectional Study in a Tertiary Care Hospital in Bangladesh

Background: Cholecystectomy is now has become a common abdominal surgery which is mostly laparoscopic in developed countries. In USA, almost 90% of cholecystectomies are laparoscopic. For gallstone surgery, laparoscopic cholecystectomy is considered as a "gold standard". Methods: This study was a cross-sectional study which was conducted at Kumudini Women’s Medical College, Mirzapur, Tangail, Bangladesh. The study was conducted in between March 2020- April 2022. The total sample size for this study was 121. Result: Most of the patients 29(24%) were aged between 20-29 years. Most of the patients 102(84%) were female whereas only 19(16%) were male. Most of the patients 61(50.4%) required 15-30 mint, 54(44.6%) required 30-60 mint and 6(5%) required more than 60 patients. 67(55%) patients stayed in the hospital for only 24 hours whereas most of the patients 42(35%) stayed for 2 days and only 12(10%) had to stay more than 2 days. Dense Adhesion was found in 4(3.3%) cases, Uncontrolled Bleeding in 3(2.5%), Fibrotic Gallbladder in 2(1.7%), and huge distended and thick Gallbladder in only 1(0.8%) case. Most common complication Wound infection was seen in 12(9.9%) patients whereas 4(3.3%) had Biliary leakage, 2(1.7%) had bile duct stricture, 2(1.7%) had Post-site Hernia. Conclusion: Laparoscopic cholecystectomy is considered to have the utmost advantages and is also related with less postoperative complications, reduce hospital stay, reduce the overall morbidity and mortality in comparison with open cholecystectomy.

ANALYSIS OF RISK FACTORS OF BILE DUCT DAMAGE: THE CONCEPT OF SAFE LAPAROSCOPIC CHOLECYSTECTOMY

The article provides a literature review from the point of view of the concept of safe laparoscopic cholecystectomy and the causes of intraoperative damage to the bile ducts.The main provisions of the concept of safe cholecystectomy include: a clear understanding of the anatomy of the biliary tract; timely use of intraoperative visualization methods; compliance with the concept of safety before dividing the cystic duct and artery in each case; awareness of the importance of time-out; obtaining a second opinion in di ffi cult cases; the importance of proper documentation. It has been proven that the greatest number of complications in laparoscopic cholecystectomy occur during the intraoperative phase, and the most common reason is «problematic visualization».The goal of promoting the «safe cholecystectomy concept» is to reduce the rate of biliary tract injury and is a worldwide initiative aimed at improving the safety of the laparoscopic method.

Efficacy of Critical View of Safety in Laparoscopic Cholecystectomy

Background: Bile duct injury is the most serious complication of laparoscopic cholecystectomy and misidentification is thought to be the most common cause. CVS is a method of exposure of hepatocystic triangle to minimize this injury. Material and methods: This prospective cohort study was conducted in the Surgical Deptt Hayatabad Medical Complex from 1st August 2018 to 31st July 2020. Results: A total of 100 patients were included with 69 females and 31 male patients with age range of 25-70 years and mean age 37 years. The mean procedure time noted was 45 minutes (35-55mins). CVS was achieved in all patients and documented in the form of video or picture as doublet view of hepatocystic triangle. No BDI was noted. Only 01 patient presented with 20ml collection in the gall bladder fossa which was treated conservatively. Conclusion: Achieving CVS during laparoscopic cholecystectomy is a safe way to minimize BDI. Incarporating CVS into our syllabus and guidelines will promote culture of safe laparoscopic cholecystectomy.

Comparing the effects of continuous infusion of esmolol and ramosetron alone and in combination on nausea and vomiting after laparoscopic cholecystectomy: A prospective, randomized, double-blind study.

Background:Postoperative nausea and vomiting (PONV) is a common complication of laparoscopic cholecystectomy. Although PONV is usually mild, severe thing can delay recovery and prolong hospitalization. We aimed to investigate the effects of ramosetron and esmolol, alone and in combination, on PONV, and pain.Methods:We enrolled 165 patients in their 20s to 50s who had an American Society of Anesthesiology physical status score of 1 or 2 and were scheduled to undergo laparoscopic cholecystectomy. They were randomly allocated into 3 groups: groups R, E, and E+R. Patients in group R received 0.3 mg of ramosetron following surgery. Those in group E were intravenously administered a bolus of esmolol (1.0 mg/kg) before endotracheal intubation. They were continuously infused with esmolol during the surgery to maintain their heart rate at 60 to 100 beats per minute and mean blood pressure at 60 to 100 mm Hg, followed by a bolus of esmolol (1.0 mg/kg) following surgery. Patients in group E+R were intravenously administered a bolus of esmolol (1.0 mg/kg) before endotracheal intubation, infused esmolol during surgery, and administered 0.3 mg of ramosetron and a bolus of esmolol (1.0 mg/kg) following surgery. We monitored the PONV stages (none, nausea, retching, and vomiting) and symptom severity in 3 postoperative stages (0–30 minutes, 30 minutes to 6 hours, and 6–24 hours), the latter by using the visual analog scale (VAS). We conducted an analysis of variance to compare VAS scores between groups.Results:Patients in groups E (mean ± standard deviation VAS score, 3.62 ± 1.00) and E+R (3.66 ± 0.71) exhibited less pain (P < .05) until 30 minutes following surgery compared to group R (5.72 ± 1.41). More patients in group E (28/50, 56%) experienced nausea compared to those in groups R (15/50, 30%) and E+R (8/50, 16%) until 30 minutes after surgery (P < .05). However, there were no differences in the severity of retching and vomiting between the groups in any of the phases (P > .05).Conclusion:Despite reducing pain after laparoscopic cholecystectomy, esmolol did not prevent PONV, whether used alone or in combination with ramosetron.

Intrapulmonary Gallstones and Pleuro-Biliary Fistula Formation Due to Complication From Prior Cholecystectomy: A Case Report and Literature Review

Intrapulmonary gallstones and the formation of pleuro-biliary fistula is a rare complication of laparoscopic cholecystectomy. The stones are most commonly found in the right lower lobe of the lungs. The symptoms tend to be insidious in nature and can manifest as hemoptysis, irritating cough, and cholelithoptysis years after the procedure. The stones can be removed through lobectomy or may also be treated non-invasively with antibiotics only. Here, we describe a case of a patient who developed hemoptysis and was found to have intrapulmonary gallstones from laparoscopic cholecystectomy and subsequent fistula formation.

Clip Migration in Common Bile Duct: An Uncommon Complication of Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the gold standard procedure for symptomatic cholelithiasis. During the procedure the cystic duct is ligated with titanium clips. Migration of these clips after cholecystectomy is a rare complication and may result in stone formation in common bile duct (CBD). We are here discussing a case of a 29 years female who presented with choledocholithiasis 10 years after laparoscopic cholecystectomy. The clip was incidentally discovered during endoscopic retrograde cholangiopancreatography (ERCP) and stone extraction. The patient was managed successfully at our center.

Impact of Standard and Low-Pressure Pneumoperitoneum on Intraoperative Complications in Laparoscopic Cholecystectomy

Aim: To compare LPP and SPP laparoscopic cholecystectomy regarding efficiency and complications Methodology: Sixty patients were enrolled. Patients were divided into two groups. 30 patients were placed in each group A and B. The intensity of postoperative shoulder pain was assessed by using visual analog scale (VAS) at 4,8,12 and 24 hours after surgery. Nausea &amp; vomiting episodes also measured at 4,8,12 and 24 hours after surgery. The length of operation, intra-operative findings, intra-operative complications (bile spilling, visceral injury and hemorrhage), and hospital stay were also noted. Results: Patients in this study were divided into two groups: group A and B. The frequency of shoulder pain at different periods was from 0 to 7 i.e. No pain, Mild, Moderate, and worst which was counted by the minimum to maximum i.e. 2 and 7 at 4 hours, 2 and 9 at 8 hours, 1 and 8 at 12 hours and 0 to 8 at 24 hours. Regarding intra-operative complications i.e. Bile Spillage, bleeding and visceral injury, only a few patients had bouts of nausea/vomiting in the 4 hours and 24 hour time intervals. However, more patients were affected by this condition at 8 and 12-hour intervals. Conclusion: LP laparoscopic surgery is an achievable alternative to SP laparoscopic procedure for benign issues of gall stone. LPP is a better choice for the LC since it minimizes post-operative pain of the shoulder &amp; the PONV while causing no significant increase in intraoperative complications. Keywords: Laparoscopic surgery, low pressure pneumoperitonium, standard pneumoperitonium

The Efficacy of Preoperative Cholangiography for Avoiding Bile Duct Injury in Laparoscopic Cholecystectomy

Introduction: Despite the development of surgical technique, iatrogenic bile duct injury (BDI) is one of the most dreadful complication of laparoscopic cholecystectomy (LC). Evidence has suggested that visual misperception accounts for 97% of BDI and aberrant right posterior sectoral hepatic duct (aPHD) is the most common and most vulnerable to BDI. This study aimed to analyze the frequency of each type of variation and efficacy of preoperative imaging. Method: From March 1, 2017 to February 28, 2021, 1477 patients who underwent cholecystectomy at Wonkwang University Hospital were enrolled. Among them, images of the 1429 patients were analyzed with magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and cholangiography using catheter via percutaneous or nasobiliary routes, selectively. Then, the types of patients confirmed to have aPHD were classified and analyzed for the presence of BDI. Results: Of the 1429 patients, 123 patients (8.61%) were found to have aPHD, of which 7 patients (0.49%) were type I, 14 patients (0.98%) were type II, 84 patients (6.97%) were type III, 2 patients (0.14%) were type IV, 7 patients (0.49%) were type IV, 9 patients (0.63%) were miscellaneous type, respectively (Fig. 3). BDI occurred in 3 patients out of 1429 patients (0.21%), and among 123 patients with aPHD, there was only a case of transected aPHD during dissection of posterior wall of gallbladder. Conclusions: It is useful to perform preoperative examination using MRCP, ERCP, cholangiography to reduce BDI through accurate understanding of the anatomy of the biliary tract before laparoscopic cholecystectomy.

Do Clinical Experience and Surgical Technique Affect Outcomes in Initial Laparoscopic Trocar Placement? A Prospective Randomized Clinical Trial

Aim: The aim of this study was to compare the intraoperative and postoperative complications of laparoscopic cholecystectomy by closed (supraumbilical Veress needle) versus open infraumbilical technique for initial, first port laparoscopic access. Patients and Methods: Our study included 560 adult patients, who were randomized into four groups (i.e., expert Veress, expert open, junior Veress, or junior open). Time for placement of the first trocar and time to complete the port-site closure were compared in all study groups. The mean operative time for cholecystectomy was compared after successful placement of the initial trocar until removal of the gallbladder. Intraoperative, early, and late postoperative complications were compared. Results: Duration of the initial port placement was significantly shorter among senior compared to junior surgeons. The Veress technique had a significantly shorter duration of port entry, but a longer duration of port-site closure compared to the open technique. Apart from the extraperitoneal insufflation incidents that were significantly more reported by junior surgeons, no significant differences in incidents were reported by senior and junior surgeons between open and closed techniques. Junior surgeons showed a better satisfaction with the open than the closed technique. Conclusions: Both the closed and open techniques for laparoscopic cholecystectomy are equally safe and effective for initial port-site entry whether performed by senior or junior surgeons. Junior surgeons are more satisfied with the open technique than the Veress needle technique, due to a perceived concern of injuring intra-abdominal structures. Therefore, junior surgeons would benefit from additional training during their residency to use both the techniques confidently.

Postoperative complications of laparoscopic cholecystectomy in children: two cases report

Only a few studies have investigated the complications of laparoscopic cholecystectomy in children. Therefore, relevant case reports will be of interest to pediatric surgeons.&#x0D; The patient was a 10-month-old boy diagnosed with calculous cholecystitis who underwent laparoscopic cholecystectomy. He had peripheral edema and adhesions in the neck of the gallbladder. After 10 h, a clinical picture of intra-abdominal bleeding developed. During relaparoscopy in the area of the gallbladder bed, arterial bleeding from the liver vessel was noted, which was eliminated by coagulation. The postoperative period was uneventful, and the child was discharged on day 8. In the second case, a 10-year-old girl was admitted for chronic calculous cholecystitis, and laparoscopic cholecystectomy was performed, in which a pronounced adhesion process was noted in the gallbladder neck region. On day 8, the child was discharged home; however, after 26 days, the patient was admitted again, with a clinical picture of diffuse biliary peritonitis. During laparoscopy, bile outflow from the gallbladder bed was noted, which only partially eliminated by monopolar electrocoagulation. Drainages were installed, through which bile began to be abundantly secreted in the postoperative period. Laparoscopy with a transition to open surgery was performed, during which a perforation in the wall of the common bile duct was found, and stenting and suturing of the defect were performed. In the postoperative period, active infusional infusion and antibacterial therapy were given. The patient was discharged on day 29.&#x0D; Postoperative complications of the ClavienDindo type IIIb are associated both with the presence of congenital anatomical features and inflammatory-adhesive changes in the Calo triangle zone and with the possibility of latent lesions during monopolar coagulation in both cases. The evaluation of the tactics of eliminating biliary peritonitis in the second patient emphasized the necessity to switch to open laparotomy during the second operation.&#x0D; These cases indicate the need to comply with the principles of safe laparoscopic cholecystectomy, including the availability of modern endoscopic equipment and the experience of surgeons in endosurgery. This requires the concentration of patients with cholelithiasis in specialized clinics.

Risk factors for bile duct injury after laparoscopic cholecystectomy: A protocol for systematic review and meta-analysis.

Background:Bile duct injury (BDI) is one of the serious complications in laparoscopic cholecystectomy (LC), but there is currently a lack of systematic review of risk factors related to BDI after LC. This study conducts meta-analysis on the risk factors related to bile duct injury after LC, the purpose is to provide reference basis for preventing and reducing BDI after LC.Methods:Using the Computer to retrieve of Chinese and English databases such as CNKI, WANFANG Data, the VIP Network, PubMed, Embase, the Cochrane Library, etc. The time is from the establishment of each database until August 2021. A case–control study is selected that is related to the risk factors of BDI after LC. This meta-analysis using RevMan 5.4 and State 12.0 software is performed after two researchers independently sift through the literature, extract the data, and evaluate the bias risk included in the study.Results:The risk factors related to BDI after LC will be analyzed by systematic review.Conclusion:The conclusion of this study will play an important role in reducing BDI after LC.OSF Registration:DOI 10.17605/OSF.IO/2B3K9, the registration URL is https://osf.io/2b3k9.

EP.TH.316Laparoscopic Cholecystectomy in KGH in 2019 - Comparing the Incidence of Complications and Patient Demographics to National Data

Abstract Aims Bile Duct injury is one of the serious complications of Laparoscopic Cholecystectomy and should be avoided. Several recent large studies that have examined Bile Duct Injuries (BDI) during cholecystectomy have found major BDI rates of 0.15-0.36% and an overall biliary complication rate of 1.5% if bile leaks are included. We wished to identify our current complication rate and compare to national data. Methods Retrospective study Data time frame from: 01/01/2019 to 31/10/2019 Type of patients: All patients who underwent elective or emergency laparoscopic cholecystectomy between the above dates Results 312 patients identified and analyzed over the study period. 227 female (72.76%) and 85 male (27.24%) 268 Elective operations (85.9%). 44 Emergency operations (14.10%) Primary outcome Secondary outcomes Conclusions KGH performed 312 cholecystectomy operations between Jan - Oct 2019, putting it in the upper 1/3 of hospitals regarding the number of operations performed per year. (1) The complication rate for the study period was 0.32%. This was one out of the 312 operations. Our incidence of complications is lower than published data reporting complication rates, including bile leaks, of up to 1.5%. There were no bile duct injuries during the study period. The majority (&amp;gt;85%) of cases were performed as elective operations.

Prevalence of Complications in Laparoscopic Cholecystectomy in Extracting Gallbladder by Using Supra-Umbilical Port Versus Epigastric Port in Sulaimani Teaching Hospital: A Prospective Case Series Study

Background: Depending on the surgeon's preference, different locations for trocar incision can be used to extract the gallbladder. Some studies are claiming that epigastric port is better for retrieval due to easiness for the surgeon as there is no need to change the position of the telescope and readjustment of the surgeon’s position. Other studies show the superiority of umbilical port in terms of pain. Setting: Sulaimani Teaching Hospital. Aims: The current work aims at evaluating the port site for gallbladder retrieval in LCin terms of time for extracting the specimen, frequency of port site pain, surgical site infection, and incisional hernia. Patients and methods: This is a prospective randomized study including 108 patients who underwent laparoscopic cholecystectomy. It was conducted in Sulaimani Teaching Hospital from October 1st, 2020, to September 30th, 2021. Patients were divided into two groups matched in gender and age: Group A: Gallbladder was extracted from the epigastric port while in Group B: Gallbladder was extracted from the supra-umbilical port. Results: A two comparable groups of patients matched in gender and age were recruited with a mean age of 41.2 + 11.04 years ranged 20-68 years. Overall, 52.78 % (n=57) were female and 47.22% (n=51) were male with F/M ratio of 1.11/1. The time of the LCfor [21±4 min] was more in group B [n= 42, 38.9%] patients in contra to group A[n=37, 34.3%] patients, while for [33±2 minutes] it was more in group A [n= 6, 5.6% ] patients. Retrieval of the almost all the excised gall bladder (n=54, 98.18% patients) via supraumbilical port needs less time (≤5 minutes) in comparison to epigastric port (n=40, 75.47% patients). Conclusion: Based on these findings the safety and ease of supra-umbilical port for extraction of gallbladder during LChas been better than that in using epigastric port. Furthermore, it has taken less operative time with less patients complained of pain or surgical site infection, abscess, and port site incisional hernia.

Frequency of Biliary Complications in Laparoscopic Cholecystectomy

Background and Aim: Laparoscopic cholecystectomy is considered the most challenging laparoscopic procedure used for gallstones removal and has a higher prevalence of bile-duct injuries compared to open cholecystectomy. The aim of the present study was to evaluate the frequency of biliary complications in laparoscopic cholecystectomy. Materials and Methods: This cross-sectional study was carried out on 40 patients with cholecystitis in Surgery department of Polyclinic Hospital, Rawalpindi Pakistan for duration from November 2020 to June 2021. An informed consent form was taken from each individual. All the symptomatic gallstones disease patients were enrolled irrespective of their age and gender in this study. Ethical approval was taken from the respective hospital ethical review committee. The Laparoscopic cholecystectomy complications were bile duct injuries, cystic artery bleeding, retained biliary stone, bile duct leakage, abdominal pain, and internal bleeding following surgery and mortality. SPSS version 20 was used for data analysis. Results: Of the total 40 cholecystitis patients, the prevalence of female and male patients were 35 (87.5%) and 5 (12.5%) respectively. The overall prevalence of laparoscopic cholecystectomy complications was found in 29 (72.5%) patients. The most prevalent complication was retained stone 13 (32.5%) cases followed by biliary duct leakage and injuries in 7 (17.5%) cases. Cystic artery bleeding was present in 5 (12.5%) cases. Other postsurgery complications were artery cystic bleeding in 3 (7.5%) cases and abdominal pain in 1 (2.5%) case. There was no mortality found among the patients. Conclusion: In the treatment of gallbladder disease, laparoscopic cholecystectomy has become the gold standard technique. However, due to the high rate of bile duct injuries, special care must be taken. Extra-biliary complications are far more common than biliary complications and can be fatal. To avoid significant morbidity and mortality in these patients, an early diagnosis and a high level of suspicion combined with sound clinical judgment are essential. Keywords: Laparoscopic cholecystectomy (LC), Cholecystitis, Biliary complications

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 &amp; 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

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.