Complication Of Laparoscopic Cholecystectomy Research Articles

Treatment of bile duct injuries during cholecystectomy

Biliary injury is a rare but a very serious complication of laparoscopic cholecystectomy (LC). Our aim was to analyse the incidence of the biliary injuries and its therapeutic outcome on patients who underwent LC or converted LC. Our research was conducted at the 1st Department of Surgery, Semmelweis University, Budapest between 2006 and 2016, retrospectively. We analysed the LCs and converted LCs performed at our Department and as well as cases where the primary operations were conducted at other institutions but they were unable to provide the adequate therapy for the injury, thus the patients were transferred to our institution. At the 1st Department of Surgery complications occurred in 0,66% (30/4885) of all LCs. 327 converted LCs were done, complications occurred in 26 (7.95%) times. 22 patients were transferred to the 1st Department of Surgery from other institutions. Bilio-vascular injuries occurred in 61% (41/78). ERCP was performed in 25 cases with a 92% success rate. Reoperation was needed in 41% (28/41). Biliary reconstruction during the reoperation was performed via hepaticojejunostomy in 82% of all reoperations. The therapeutic solutions of LC’s complications are complex. Therefore, the treatment is recommended only in institutions with appropriate experience.

Retrospective analysis of complications in 3600 patients of laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy results in specific complications which occur frequently as compared to open cholecystectomy. Several aspects of these complications and their treatment modalities were analyzed.Methods: 3600 cases of laparoscopic cholecystectomy performed by a single surgeon at various private hospitals in Jammu (Jammu and Kashmir), India during the period of 18 years from March 2002 to March 2020 were analyzed for the complications and their management.Results: Complications of laparoscopic cholecystectomy occurred in 14.5% of the patients. The most common complication was haemorrhage. Conversion to open cholecystectomy was necessary in 41 (1.13%) patients due to obscure anatomy as a result of adhesions and acute inflammation. In the study, 6 deaths (0.16%) were recorded.Conclusions: Laparoscopic surgeon should remain highly vigilant to detect major complications like injury to small gut at the time of entry into the peritoneal cavity or bile duct injury during laparoscopic cholecystectomy at an earliest and should timely manage such cases to save the life of the patient.

Hemobilia due to Spontaneous Rupture of Cystic Artery Pseudoaneurysm: A Rare Complication of Laparoscopic Cholecystectomy

Hemobilia due to Spontaneous Rupture of Cystic Artery Pseudoaneurysm: A Rare Complication of Laparoscopic Cholecystectomy

Complications of Laparoscopic Cholecystectomy in a Sample of Patients Admitted to Al-Ramadi Teaching Hospital, Anbar-Iraq

Laparoscopic cholecystectomy is currently thought as a surgical procedure that can be done with less risk of complications. However, intraoperative and postoperative complications were existing in 56 (15.01%) patients. Open surgery is the case when laparoscopic cholecystectomy fails to be proceeded with due to many causes such as difficult Calot triangle dissection and empyema of gallbladder. The high occurrence of cholecystitis in the group of patients aged 40-60 (56%) with 151 female and 59 males initiating the floor to many arguments that may help give a good understanding for such a problem. Iatrogenic perforation of gallbladder was the most common cause of intraoperative complications. Wound infection was the most cause of postoperative complications. Difficult Calot triangle dissection was the most common cause to convert to open surgery.

Intra-operative factors responsible for conversion of laparoscopic cholecystectomy to open cholecystectomy in a tertiary care center

Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis and has multiple advantages over open approach. With increasing skills and techniques over the years, the contra-indications to laparoscopic cholecystectomy have reduced. Even after careful selection of appropriate candidates for laparoscopic cholecystectomy, it sometimes becomes necessary to convert into an open cholecystectomy to prevent complications. This study was undertaken so as to identify the intra-operative factors necessitating conversion of laparoscopic cholecystectomy to open cholecystectomy.Methods: In this study conducted at S. P. Medical College and P. B. M. Hospital, Bikaner, over a period of 1 year, 100 consecutive patients with symptomatic cholelithiasis, planned for laparoscopic cholecystectomy were included. Laparoscopic cholecystectomy was performed and cases which could not be completed laparoscopically were converted to open cholecystectomy via right subcostal incision. Intra-operative factors necessitating conversion were observed and analyzed.Results: The incidence of conversion was found to be 7%. The most common intra-operative factor for conversion was dense adhesions at the Calot’s triangle (71.43%) followed by obscure anatomy (42.86%). Uncontrolled bleeding and CBD stones also led to conversion. The identification and appearance of CBD and achievement of critical view of safety were significant factors for conversion to open cholecystectomy (p=0.0001).Conclusions: The rate of conversion to open cholecystectomy was 7% which is comparable to similar studies. Conversion is not a failure or complication but actually a safer alternative to ensure completion of the procedure without any real complications of laparoscopic cholecystectomy- biliary or visceral injury, haemorrhage, etc.

Perioperative complications of laparoscopic cholecystectomy: a cross-sectional observational study

Background: Laparoscopic cholecystectomy (LC) has now become the gold standard in treatment of benign gall bladder disease. The intraoperative and immediate postoperative complication cannot be disregarded and remain of concern. The study aims to evaluate the perioperative complications of LC in patients undergoing the surgery.Methods: A total of 100 patients were included in this prospective analytical study from a June 2017 to September 2019. They were adequately evaluated and underwent LC in General surgery department of Geetanjali Medical College and Hospital, Udaipur. The relevant clinical details of all the patients were recorded and analysed.Results: Among the patients who underwent LC, majority were females. In case of 86 patients, LC was done due to chronic calculous cholecystitis. The conversion rate from laparoscopic to open was 6%. The most frequent intraoperative complication was trocar site bleeding and liver bed injury, 7%, followed by bile leakage from gallbladder 6%, bleeding from calots triangle in 4% and spilled gallstones in 2% cases. There was no case of injury to common bile duct, bowel injury or major vascular injury. Amongst the post-operative complications, wound infection was in 1% case. No perioperative mortality was present. The overall rate of complication was 18%.Conclusions: LC is a safe and effective procedure in almost all patients presenting with symptomatic gallbladder disease and remains one of the most frequently performed laparoscopic operations. It has a low rate of mortality and morbidity making this operation a safe procedure with favourable results.

Fluorescent Cholangiography in Laparoscopic Cholecystectomy and the Use in Pediatric Patients.

Background: Common bile duct (CBD) injury is one of the most serious complications of laparoscopic cholecystectomy and carries an incidence of 0.3%-0.7%. Recently indocyanine green (ICG) fluorescent cholangiography (FC) has been used as an adjunct to identify the biliary tract during adult laparoscopic cholecystectomy, allowing intraoperative identification of biliary anatomy. The objective of this article is to show its successful use in pediatric laparoscopic cholecystectomies. Method: From July 1, 2017, to November 30, 2018, surgeons at John R. Oishei Children's Hospital and Women and Children's Hospital of Buffalo have been utilizing ICG-FC as an adjunct in patients undergoing laparoscopic cholecystectomy. Thirty-one patients undergoing laparoscopic cholecystectomy had 1 mL of dilute ICG (2.5 mg) injected intravenously in the operating room (OR) before trocar placement. Demographics, intraoperative details, and subjective surgeon data were recorded for elective laparoscopic cholecystectomy cases involving ICG. We hypothesize that use of ICG-FC in the pediatric and adolescent patient population is a safe, reliable, and reproducible adjunct for identification of the biliary tree. Secondary outcomes were to identify rate of biliary anatomy identification, utilization ease, and operative times while using ICG technology in pediatric patients. Results: ICG-FC was used in 31 pediatric laparoscopic cholecystectomies performed by 5 surgeons at our institution. Ages ranged from 6 to 18 years. In all cases, the cystic duct-CBD junction was visualized while performing dissection of the triangle of Calot. No intraoperative complications occurred. Conclusions: ICG-FC provides a noninvasive real-time visualization of the extrahepatic biliary tree in children and adolescents. We demonstrate that ICG-FC can successfully be used as an adjunct in pediatric patients and has the potential to facilitate with the dissection and minimize risk of bile duct injuries during pediatric laparoscopic cholecystectomies.

The impact of surgical experience on complications of laparoscopic cholecystectomy

Objective: Laparoscopic cholecystectomy (LC) is the gold standard option for the surgical treatment of cholecystitis. Meanwhile, experience of surgical center and operator play central role in adequate management of patients with gallbladder disorders. The aim of this study is to analyze complications and conversion rates of laparoscopic cholecystectomy at various periods of implication of the method in a single center. Methods: We retrospectively analyzed early complications of 6381 patients operated due to various forms of cholecystitis according to periods of implication of LC in Kyrgyz National Center of General Surgery (1996-2019). Patients were divided into 3 groups: first group of patients were operated from 1996 to 2004 during first implementation of technique (n=1446); second group patients underwent operation between 2005-2008, when operators concentrated on technical skills (n=1225); third group of patients operated between 2009 and 2019, when surgical team concentrated on prevention of complications. Results: Both complication and conversion cases represented strong association with surgical experience. The highest complications (4.8% vs 1.5% and 0.4%, respectively, p<0.001) and conversion to surgical cholecystectomy (11.2% vs 1.5% and 0.1%, respectively, p=0.001) rates were detected in group 1 as compared to groups 2 and 3. Conclusion: Occurrence of complications and conversion to conventional surgical cholecystectomy reduced over time, depending on surgical experience of operating team and practice of operator.

Retrograde tracing along "cystic duct" method to prevent biliary misidentification injury in laparoscopic cholecystectomy.

Bile duct injury remains the most serious complication of laparoscopic cholecystectomy (LC), the main cause was misidentification of cystic duct (CD). The aim of this study was to evaluate the effectiveness and security of retrogradetracing along "cystic duct" (RTACD) method for the prevention of biliary misidentification injury in LC. The conception of RTACD method was first described and then illustrated by simulation dissection with extrahepatic biliary structure charts. A total of 840 patients undergoing LC were selected. After the "CD" was separated during operation, its authenticity was identified by RTACD method according to its course and origin. The "CD" can be clipped/divided only when it was identified to be true CD. Among 840 patients, the initially separated "CD" was identified as actual CD in 831 cases, common hepatic (bile) duct in six cases, accessory right posterior sectoral duct in two cases, and right haptic duct in one case. LCs were successfully finished in 837 patients, and converted to open cholecystectomy in three cases. The average operation time was 64.23min (range 25-225min), and the average blood loss was 8.07ml (range 2-200ml). No biliary misidentification injury was found. All patients recovered smoothly. No jaundice or abdominal pain was noted in the patients during 1-19months follow-up. RTACD method is a safe and effective new technique of preventing biliary misidentification injury.

Case report: cystic artery pseudoaneurysm presenting as a massive per rectum bleed treated with percutaneous coil embolization

BackgroundCystic artery pseudoaneurysms are rare. It usually occurs as a complication of laparoscopic cholecystectomy, but can arise uncommonly as a complication of acute cholecystitis. Ruptured cystic artery aneurysms present with haemobilia, intraperitoneal or upper gastrointestinal bleeding. We present an unusual case of cystic artery aneurysm presenting as a massive lower gastrointestinal bleed.Case presentationA 47-year-old man was admitted with a thoracic abscess and was noted incidentally on CT to have acute cholecystitis. Subsequently the patient then presented with massive fresh PR bleeding. This was found on CT to be the result of a cystic artery pseudoaneurysm with associated gallbladder fistulation to the hepatic flexure, secondary to cholecystitis. The patient was treated with coil embolisation of the cystic artery made a full recovery and was discharged with a view to performing an elective cholecystectomy.ConclusionCystic artery pseudoaneurysm is a rare complication of cholecystitis which can present as massive lower gastrointestinal haemorrhage secondary to cholecystocolic fistula. Percutaneous embolization is a safe and effective treatment in the acute phase.

Isolation and Clipping of Cystic Artery outside Versus inside Calot?s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy (LC) is the “Gold Standard“ for the treatment of cholelithiasis and acute cholecystitis, and is the commonest operation performed laparoscopically worldwide. In spite of this fact , still the most serious complications like extrahepatic bile duct injury (BDI) & vascular injury, are more common in LC than OC(open cholecystectomy).Objectives: to compare between the isolation & clipping of cystic artery outside & inside Calot’s triangle in regard of minimizing the intraoperative complications in LC. Patients and methods: This is a prospective( therapeutic controlled trial ) study of 508 patients with symptomatic gallstones (456/508=90% females & 52/508=10% males) who were admitted to Al-Diwaniya teaching hospital to undergo LC from April 2015 to April 2018.Group–A-: consists of 272 patients (246/272=90.4% F & 26/272=9.6% M) selected to undergo a LC with standard conventional technique of dissection of cystic pedicle. Group –B-: consists of 236 patients (210/236=89% F & 26/236=11% M) selected to undergo LC with isolation & clipping of cystic artery outside the Calot’s triangle. Results: Cystic artery injury: In group-A-(29/272=10.7%) vs (8/236=3.4%) in group–B-. The control of bleeding in group-A-(34%=10/29) vs (100%=8/8) in group-B. Clipping was used to control bleeding in group-A-(5/29=17%) vs (8/8=100%) in group-B-, while electrocoagulation used in group-A-(5/29=17%) vs (0/8=0%) in group-B-. The conversion done in group-A- in (19/272=7%) vs (0/8=0%) group-B- A sizable posterior branch was identified in group-A-(6/272=2.2%) vs (62/236=26.3%) in group–B-.In group–A- the clear identification of the anatomy achieved in (202/272=74%) vs (236/236=100%) in group-B-. The conversion rate due to poor identification of the anatomy or complex anomalies in group-A-(4.4%=12/272) vs (0%) in group-B-.Conversion from LC to OC: The total conversion rate in group–A-(36/272=13.24%) vs (0%) in group-B-.. No mortality reported in our study. Conclusion: This technique significantly minimizes the overall conversion rate in LC. How to Cite this Article Pubmed Style Adel Mosa Al-Rekabi. & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. SRP. 2020; 11(10): 123-127. doi:10.31838/srp.2020.10.21 Web Style Adel Mosa Al-Rekabi. & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. http://www.sysrevpharm.org/?mno=10512 [Access: March 29, 2021]. doi:10.31838/srp.2020.10.21 AMA (American Medical Association) Style Adel Mosa Al-Rekabi. & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. SRP. 2020; 11(10): 123-127. doi:10.31838/srp.2020.10.21 Vancouver/ICMJE Style Adel Mosa Al-Rekabi. & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. SRP. (2020), [cited March 29, 2021]; 11(10): 123-127. doi:10.31838/srp.2020.10.21 Harvard Style Adel Mosa Al-Rekabi (2020) & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. SRP, 11 (10), 123-127. doi:10.31838/srp.2020.10.21 Turabian Style Adel Mosa Al-Rekabi. 2020. & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Reviews in Pharmacy, 11 (10), 123-127. doi:10.31838/srp.2020.10.21 Chicago Style Adel Mosa Al-Rekabi. Isolation & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. Systematic Reviews in Pharmacy 11 (2020), 123-127. doi:10.31838/srp.2020.10.21 MLA (The Modern Language Association) Style Adel Mosa Al-Rekabi. Isolation & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Cholecystectomy. Systematic Reviews in Pharmacy 11.10 (2020), 123-127. Print. doi:10.31838/srp.2020.10.21 APA (American Psychological Association) Style Adel Mosa Al-Rekabi (2020) & Clipping of Cystic Artery outside Versus inside Calot’s Triangle Minimizes the Intraoperative Complications in Laparoscopic Reviews in Pharmacy, 11 (10), 123-127. doi:10.31838/srp.2020.10.21

Risk Factors of Postoperative Complications in Laparoscopic Cholecystectomy for Acute Cholecystitis.

Introduction:There are often cases with postoperative complications after laparoscopic cholecystectomy (LC), resulting in severe consequences. This study aimed to identify potential risk factors of postoperative complications in cases of LC for acute cholecystitis.Materials and Methods:A total of 423 patients with cholecystitis underwent LC. We divided the patients into two groups: group without postoperative complications (Group A) and group with postoperative complications (Group B). Pre-operative findings, surgical findings, and the methods for evaluating the risk of peri-operative complications were compared between the two groups with a univariate analysis. Independent risk factors of postoperative complications were then evaluated in a multivariate analysis with the factors shown to be statistically significant in the univariate analysis.Results:A Physiological and Operative severity Score for enUmeration of Mortality and morbidity (POSSUM) of ≥ 48.3 and moderate or severe cholecystitis were independent risk factors of postoperative complications in LC.Conclusions:This study indicated that POSSUM morbidity and moderate or severe cholecystitis were potential risk factors of postoperative complications. The pre-operative management of the general condition and cholecystitis using antibiotics, infusion, percutaneous transhepatic gallbladder drainage, and other approaches may be significant for the prevention of postoperative complications. Once the POSSUM morbidity reaches the threshold after LC, postoperative management becomes difficult, so strict control of the general condition should be performed.

Validación de escala pronóstica de conversión a cirugía abierta en colecistectomía laparoscópica

Introducción: La conversión a cirugía abierta es una complicación de la colecistectomía laparoscópica, ya sea por dificultad en la disección o por la falta de experticia del cirujano. Actualmente es complicado predecir la dificultad de una cirugía laparoscópica de vesícula biliar.
 Objetivo: Evaluar la sensibilidad de la ecografía para colecistitis y colelitiasis y su relación con los hallazgos transoperatorios en cirugías de vesícula biliar
 Material y Métodos: Se realizó un estudio observacional retrospectivo con la revisión de las historias clínicas de aquellos pacientes intervenidos quirúrgicamente por patologías de vesícula biliar y que presenten ecografía como medio diagnóstico en el Hospital General Docente Ambato de Junio a Diciembre de 2018.
 Se evalúo la posible dificultad quirúrgica con una escala pronóstica ecográfica y posteriormente se comparó con los hallazgos quirúrgicos y la existencia de conversión.
 Resultados: La correlación de la dificultad quirúrgica (cirugía mayor a 90 min o convertida) en relación con la escala predictiva (posible cirugía complicada score ≥5) es de 73% (sensibilidad) y la probabilidad que la escala prediga una cirugía no complicada es del 71% (especificidad), con un OR: 7.785 (IC: 0.789 – 78.511), con un test de Fisher (X2 modificado) de 2.225 con una p = 0.074. La relación no es estadísticamente significativa.
 Conclusiòn La escala pronóstica ecográfica utilizada en los pacientes del Hospital General Docente Ambato no predice la dificultad quirúrgica de los pacientes sometidos a cirugía laparoscópica de vesícula

Ectopic right anterior inferior segmental bile duct and iatrogenic proximal bile duct injury: report of eight patients

Objective To summarize our clinical experience and management of an anomalous proximal bile duct joining the cystic duct in laparoscopic cholecystectomy (LC). Methods A retrospective study was conducted on 8 patients who had an anomalous right anterior bile duct joining the cystic duct who were treated at the Hunan Provincial People's Hospital from March 2003 to January 2019. Results All the 8 patients were diagnosed to have gallstones cholecystitis on preoperative CT, MRI and abdominal ultrasound. There were no suggestions of an anomalous bile duct. A total of 6 patients underwent reoperation after LC due to abdominal pain and biliary peritonitis. These 6 patients were treated with drainage and T-tube insertion. In the other 2 patients, the anomalous bile duct opening which joined the cystic duct were detected during LC. There was one patient converted to open laparotomy with preservation of the cystic duct and underwent common bile duct T-tube drainage. The other patients continued with laparoscopic surgery. The cystic duct was partially resected with removal of gallbladder, followed by common bile duct drainage. The average follow-up period was 3.4 years and the results were satisfactory. Conclusions Biliary duct anomaly is the main cause of iatrogenic proximal bile duct injury during laparoscopic cholecystectomy. It is not uncommon to have the anomaly of insertion of right anterior segmental bile duct to the cystic duct. To avoid iatrogenic biliary tract injury, careful preoperative study of X-ray films, accurate identification of the intraoperative gallbladder triangle anatomical structures. Strict adherence to carry out the three-word procedure of discrimination, cut, identify will help to reduce the incidence of biliary tract complications in laparoscopic cholecystectomy. Key words: Cholecystectomy; Biliary duct injury; Bile duct variation; Right lower anterior lobe; Repair strategy

Complications of Laparoscopic Cholecystectomy

Background: laparoscopic cholecystectomy is now regarded as the "Gold Standard" treatment option for benign gallbladder disease. But it is not free of procedure related complications. Objective: To review the complications of laparoscopic cholecystectomy for gall stone disease.
 Materials & Method: A prospective observational study was carried out over a period of 9 years beginning from 1st of July 2003 till 30th of June 2012 in Comilla Medical College Hospital and several private hospitals of Comilla. A total of 946 patients who underwent laparoscopic cholecystectomy for symptomatic and asymptomatic gallstone disease as confirmed by ultrasound scan were included. Patient having cirrhosis of liver, ischaemic heart disease, suspected carcinoma of gall bladder were excluded from the study. The outcome including the complications was analyzed.
 Result: Out of 946 patients 632 (66.80%) were females and 314 (33.19%) were males. Most (92.3%) of them were between 21-50 years of age. The commonest immediate complication was bleeding from liver bed (9.40%), from vascular injury in Callot's triangle (5.17%) and from the trocar site (4%). There was spillage of gallstones in 104(10.99%) cases. Bowel injury was seen in only one (0.10%) case. Bile leakage was observed in 4(.42%) cases that also include CBD injury .in 3 cases. The procedure was converted to open surgery in 11(1.17%) cases. Port site infection was seen in 43 (4.54%) cases. Late complications include port site hernia in 6 (0.63%) cases, port site keloid in 1 (.1%) case and CBD stricture in 5 (0.54%) cases. Mortality was unavoidable in in 2(0.21%) cases.
 Conclusion: With increasing experience laparoscopic cholecystectomy can be a safe and effective procedure for most patients with cholelithiasis. Proper training and sound knowledge of possible complications can yield favorable results and lesser complications.
 Journal of Surgical Sciences (2013) Vol. 17 (2) :73-79

Complications of laparoscopic cholecystectomy performed by junior surgeon in resource-restricted settings

Background: The aims of this audit were to determine the rate of complications of laparoscopic cholecystectomy performed by a junior surgeon, to identify changes that can be made to reduce the complications, and to re-audit the complication rate after the changes have been made.Methods: Laparoscopic cholecystectomies performed by the surgeon between August and November, 2018 were assessed retrospectively. Data was collected from electronic records and operation notes and entered in the format as enclosed within. A re-audit was conducted between December 15th, 2018 and June 15th, 2019.Results: In the initial audit, the complication rate of laparoscopic cholecystectomy was 40% and the incidence of bile leaks was 6%. The re-audit showed a significant reduction in the overall complication rate to 24% with no incidence of bile leaks.Conclusions: The learning curve of surgeons for laparoscopic procedures is steep and cases should be chosen carefully depending on the current skill set and comfort level of the surgeon. Recommended standard practices should be followed in all situations, and all the team members should be involved in identifying risks during the surgery.

Hemobilia: an unusual and life threatening complication of laparoscopic cholecystectomy

Hemobilia though rare, occurs due to abnormal vascular and biliary communication established as a result of trauma, gallstones, neoplasms, inflammatory process and vascular disorders. It can rarely complicate a laparoscopic cholecystectomy as a result of hepatic artery injury, clip migration, clip erosion, diathermy and subsequent arteriobiliary fistula, or pseudoaneurysm eroding into the extra hepatic bile ducts. A 34 years female underwent laparoscopic cholecystectomy for cholelithiasis, suffered bile leak that settled on by 13th postoperative day, met with sudden right upper abdominal pain and hypovolemic shock on 15th postoperative day due to massive hemobilia arising out of rupture of pseudoaneurysm of the right hepatic artery into the biliary system. Urgent CT Angiography showed a large pseudoaneurysm of right hepatic artery branch with adjacent small collection, IHBR and CBD dilatation suggestive of hemobilia. Emergency CT guided trans-arterial hepatic artery embolization done to control hemobilia and save the patient. An immediate CT angiography for early diagnosis, in all postoperative laparoscopic cholecystectomy cases with suspicion of hemobilia due to an underlying hepatic artery pseudoaneurysm, followed by CT guided trans-arterial hepatic artery embolization forms the gold standard management in such patients.

Peritoneal lavage: a simple tool to prevent bleeding during and after laparoscopic cholecystectomy.

Bleeding remains one of the most serious complications of laparoscopic cholecystectomy and can increase mortality. Even if several patient-related and intraoperative factors increase the risk of bleeding, complete hemostasis should be achieved at the end of each surgical procedure. Although irrigation is a standard step, its importance is often underestimated. This commentary highlights the efficacy of peritoneal lavage in identifying bleeding sources and the effect of saline temperature.

For the 30th anniversary of laparoscopic cholecystectomy: problems remain

The review describes perioperative complications of laparoscopic cholecystectomy. Over the past 30 years, laparoscopy has become the «gold standard» for cholecystectomy and one of the most frequently performed procedures in abdominal surgery. Nevertheless, despite the advantages of the method, it has an «Achilles heel» - the frequency of iatrogenic damage to the extrahepatic bile ducts is 3-5 times higher than with an open cholecystectomy. This complication has a negative effect on the survival of patients after surgery, leads to deterioration in the quality of life and is a major source of legal costs in many countries. In general, the total range for any damage to the biliary tract during laparoscopic cholecystectomy is 0.32-0.52%, while the complication rate and mortality rate are 1.6-5.3% and 0.08-0.14%, respectively. Patients who have undergone a complete intersection of the hepaticoholedochus, become «bile cripples» for life. Recurrent cholangitis, strictures of anastomoses with a possible outcome in liver cirrhosis are quite likely in later periods after damage to the intrahepatic bile ducts. Technological efforts to improve the results of laparoscopic cholecystectomy reside. These include the routine use of intraoperative cholangiography, infrared fluorescent cholangiography, etc. Nevertheless, despite the growing number of methods designed to reduce these complications, evidence of their effectiveness remains limited. The most important factors ensuring the safety of laparoscopic cholecystectomy are recognized: understanding of anatomy, adequate exposure when using electrosurgery, psychological readiness to invite a senior colleague in time for help, the ability to recognize a situation that requires conversion and rejection of laparoscopy.

Complications of Laparoscopic cholecystectomy at Muhammad Medical College Mirpurkhas: Audit of 100 cases.

Introduction: The main objective was to determine the complications of laparoscopic cholecystectomy (LC) and its cause at Muhammad Medical College Mirpurkhas.Methodology: This is prospective study carried out from February 2008 to January 2016. Data of all patients undergoing elective laparoscopic cholecystectomy during the study period and fulfilling the selection criteria was collected and entered in standard proforma and analyzed on SPSS 10.Result: A total number of ten patients underwent laparoscopic cholecystectomy with an overwhelming majority of females (87 out of 100). The age ranges from 22-60 years mean age being 38 years. The overall complication rate was 9%. The complication included bleeding (4/100, 4%) from cystic artery and gall bladder bed, port site infection (4/100 4%) One patient developed collection in pouch Morrison and one patient was developed stitch granuloma. There was no bile duct injury and colonic injury. The most common cause of these complications was accidental injury to cystic artery and gross spillage of infected bile.Conclusion: Bleeding and port site infections were common post-operative complication; the most common cause of bleeding was cystic artery injury whereas the commonest cause port site infection was gross spillage of infected bile.Key Words: Laparoscopic endoscopy, cholelithiasis, complications