Gallbladder adhesion degree as predictor of conversion surgery, common bile duct injury and resurgery in laparoscopic cholecystectomy: A cross-sectional study

Abstract

Background The gold-standard treatment for cholecystectomy, laparoscopic cholecystectomy, has remarkably variable outcomes and conversion rates. We investigated the gallbladder adhesion degree as a predictor of conversion surgery, common bile duct injury, and resurgery. Methods We reviewed 157 medical records and video recordings of laparoscopic cholecystectomy on patients with cholelithiasis with or without cholecystitis at three hospitals in Yogyakarta, Indonesia from January 2016 to December 2018. The degree of gallbladder adhesion is classified into 4 categories: no adhesion, <50% adhesion, 50%-buried GB, and completely buried GB. Results One hundred fifty seven patients were involved in this study, of whom 58 were males and 99 females with average age 49.2. Eighty-one patients out of 157 patients (51.6%) had gallbladder adhesion comprising of 61/157 (38.9%) with <50% adhesion and 20/157 (12.7%) 50%-buried GB. There is one incidence each of conversion surgery, CBD injury, and resurgery. The degree of GB adhesion has low degree of correlation with conversion surgery, CBD injury, and resurgery wirh r value of 0.156, 0.041, and 0.156 respectively. There is significant correlation between the degree of GB adhesion and conversion surgery and resurgery with p value of 0.032, and 0.032 respectively. There is no significant correlation between degree of GB adhesion and CBD injury with p value of 0.453. Conclusion The degree of GB adhesion has low degree of correlation with conversion, CBD injury and resurgery. This study also showed that patients with high degree of gallbladder adhesion are still eligible for laparoscopic procedure performed by an experienced surgeon.

Predective Factors of Common Bile Duct Injury in Laparoscopic Cholecystectomy

“…This generation of adhesions may be rather painful. In the context of surgical operations, the existence of this phenomena might possibly provide a severe impediment, hence raising the chance of negative results made by Handaya et al (12) .…”

Can the degree of fibrosis in the gallbladder wall be predicted by preoperative routine examinations in chronic cholecystitis? Retrospective analysis

“…Gallstones present clinically as acute cholecystitis or symptomatic chronic cholecystitis (CC). [1,2] Elevated inflammatory markers and increased gallbladder wall thickness in acute cholecystitis help predict the increased risk of intraoperative bile duct injury and post-operative complications. [3] However, this risk is more difficult to predict in CC.…”

“…Depending on the degree of fibrosis, the tissue becomes scarred and hardened. [1,2,5] Due to this hardening, it becomes difficult to perform the critical view of safety in the Calot's triangle during the gallbladder surgeries and the risk of biliary tract injury increases. [6][7][8][9] It is difficult to predict these chronic changes in the pre-operative period.…”

Risk factors for bile duct injury after laparoscopic cholecystectomy

“…[1,2] Bile duct injury (BDI) is a kind of serious and difficult surgical complications, and these complex injuries are often caused by LC, the incidence rate can reach 0.3% to 1.4%. [3,4] The associated BDI after LC may lead to biliary peritonitis, bile duct stenosis, obstructive jaundice, biliary tract infection, and even more serious complications such as biliary cirrhosis, portal hypertension, liver atrophy, etc, which can increase the patient's pain, affect their postoperative recovery, and even endanger the patient's life and safety. [5][6][7] Therefore, it is of great significance to analyze the risk factors that affect the related to BDI after LC and to formulate effective prevention and treatment strategies according to it.…”

“…Laparoscopic cholecystectomy (LC) is a common method for treating gallbladder diseases, with the advantages of small trauma, simple surgical operation, short surgical time, fast recovery after surgery, etc [1,2] . Bile duct injury (BDI) is a kind of serious and difficult surgical complications, and these complex injuries are often caused by LC, the incidence rate can reach 0.3% to 1.4% [3,4] . The associated BDI after LC may lead to biliary peritonitis, bile duct stenosis, obstructive jaundice, biliary tract infection, and even more serious complications such as biliary cirrhosis, portal hypertension, liver atrophy, etc, which can increase the patient's pain, affect their postoperative recovery, and even endanger the patient's life and safety [5–7] .…”