Acute Kidney Injury Following Conversion From Laparoscopic to Open Cholecystectomy

Abstract

Pneumoperitoneum during laparoscopic surgery is a complex physiologic event associated with neuroendocrine, respiratory, cardiovascular and renal disturbances as well as compromised organ blood flow. Impaired renal perfusion from pneumoperitoneum is attributed to intra-abdominal hypertension. Several mechanisms contribute to acute kidney injury (AKI) in such patients, including renal vein compression with impairment of the venous drainage. Renal artery vasoconstriction induced by the neuro-hormonal systems worsens outcomes. The final result is progressive reduction in both glomerular perfusion and urine output. We present a case of 58-year-old man who underwent open cholecystectomy following a failed laparoscopic cholecystectomy attempt. Postoperatively, he developed AKI. This was attributed to pneumoperitoneum, an essential part of the laparoscopic procedure. This case illustrates that even when there are no obvious risk factors for postoperative complications, a high index of suspicion should be maintained for early recognition and treatment of complications from this surgery.

Laparoscopy-induced severe renal failure after appendectomy

“…The patient required emergency hemodialysis due to fluid overload, and posteriorly was dependent on renal replacement therapy [ 4 ]. Cases of AKI after laparoscopic cholecystectomy have been also reported in literature concerning both patients with CKD [ 5 , 6 ] and with no previous RF impairment [ 7 , 8 ], similar to the case we describe.…”

“…According to international consensus, IAP is defined by a pressure >12 mmHg; abdominal compartment syndrome is considered when IAP >20 mmHg accompanied by organ dysfunction [ 4 , 6 , 9 , 10 ]. AKI is one of the first signs in this syndrome [ 4 , 6 , 10 ]. Laparoscopic pneumoperitoneum induced IAP can compromise kidney functionality.…”