Complications of laparoscopic cholecystectomy

The problem of iatrogenic damage to the extrahepatic bile ducts during cholecystectomy remains relevant. Insufficient experience of the surgical team, limited knowledge of the topographic anatomy of the subhepatic space, especially in conditions of perivesical inflammatory infiltrate, poorly timed access conversion are some of the main reasons.The results of treatment of these patients depend on the timing of recognition of the injury, the type of the injury, the characteristics of reintervention, and timely reconstructive surgery performed in a specialized center. Up to 30 % of damage occurs due to combined injury to the extrahepatic bile ducts and afferent vessels of the liver, which aggravates the course of the disease.We report a clinical case of a female patient. The fragment of the hepaticocholedochus was excised during a planned cholecystectomy. In the same clinic, the primary reconstructive operation was performed (drainage of the hepaticocholedochus using a Kehr’s drain). Afterwards, an external fistula of the common hepatic duct was formed. The reconstructive operation was performed 4 days after the initial operation, in a specialized department of the regional clinical hospital. Relaparotomy was performed. In a dense inflammatory infiltrate during mobilization of the suspected hepaticocholedochus, a Kehr’s drain was identified, which distal branch was not located in the lumen of the bile duct. Thrombosis of the right hepatic artery was diagnosed. The Kehr’s drain was removed, the lobar ducts were identified to their confluence, and the confluence was preserved. The distal stump was sutured. Next, arteriotomy and thrombectomy were performed, and adequate retrograde and antegrade blood flow was recoverd. A hepaticoenteroanastomosis has been formed. The patient was discharged with recovery. When examined after 2 months, the condition was satisfactory. Timely diagnosis of thrombosis of the right hepatic artery, adequate revascularization and biliary reconstruction made it possible to avoid liver necrosis and achieve a good treatment outcome.

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Our Experience of 4360 Laparoscopic Cholecystectomy for Cholelithiasis

Бокиев¹,

Rashidov²,

Рахмонов³

et al. 2020

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Objective: Analysis of our own experience in performing laparoscopic cholecystectomy (LCE) for cholelithiasis (CHL). Methods: The study is based on the results of 4360 LCE in patients with cholelithiasis. Among the patients, women predominated – 3732 (85.6%), the average age of patients was 52.0±3.5 years. The structure of nosologies: chronic calculous cholecystitis – 3310 (75.9%), acute calculous cholecystitis – 1050 (24.1%). The operations were performed under general endotracheal anaesthesia with carbon dioxide insufflations; the location of the operating team was of the «American» type. Results: LCE was performed in 96.5% of patients, access conversion to open surgery was required in 3.5% of cases. The most common causes of conversion were the presence of a massive adhesive process (59.6%) and destructive changes in the walls of the gallbladder (9.93%). In the ICU, the operated patients were observed on average for 4±2.5 hours, the postoperative stay of patients in the hospital ward was 1.7±1.2 days. Immediate postoperative complications were noted in 1.63% of cases, mortality was 0.13%. Conclusions: Based on their own experience, the authors agree with the postulate that the LCE is the «gold standard» in gallbladder surgery in patients with gallstone disease. At the same time, purposeful preoperative preparation, careful selection of patients, high qualification of the surgeon, as well as adequate postoperative management of patients are the main factors in achieving good outcome. The complexity of surgical techniques can be reduced by collectively addressing complex situations of general somatic status by the active involvement of associated professionals. Keywords: Gallstone disease, laparoscopic cholecystectomy, conversion, early postoperative complications.

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Complications of laparoscopic cholecystectomy

Cited by 5 publications

References 4 publications

Some aspects of iatrogenic vessel injury

Some aspects of iatrogenic vessel injury

Restoration of Bile Outflow and Liver Revascularization After Cholecystectomy with Damage to the Hepaticocholedochus and Thrombosis of the Right Hepatic Artery

Our Experience of 4360 Laparoscopic Cholecystectomy for Cholelithiasis

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