Even though laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed.
Materials and methods
Over the last 9 years 9542 LCs have been performed at this centre, of which 13.9% were carried out for acute cholecystitis, 38.4% in obese patients and 7.6% in patients aged >65 years.
The main operative incidents encountered were haemorrhage (224 cases, 2.3%), iatrogenic perforation of the gallbladder (1517 cases, 15.9%) and common bile duct (CBD) injuries (17 cases, 0.1%). Conversion to open operation was necessary in 184 patients (1.9%), usually due to obscure anatomy as a result of acute inflammation. The main postoperative complications were bile leakage (54 cases), haemorrhage (15 cases), sub-hepatic abscess (10 cases) and retained bile duct stones (11 cases). Ten deaths were recorded (0.1%).
Most of the postoperative incidents (except bile duct injuries) were solved by laparoscopic means. Among patients with postoperative complications 28.9% required revisional surgery. In 42.2%
of cases minimally invasive procedures were used successfully: 15 laparoscopic re-operations (for choleperitoneum, haemoperitoneum and subhepatic abscess) and 22 endoscopic sphincterotomies (for bile leakage from the subhepatic drain and for retained CBD stones soon after operation). The good results obtained allow us to recommend these minimally invasive procedures in appropriate patients.
Keywords: laparoscopic cholecystectomy, incidents, complications, minimally invasive treatment of complications
During the past decade laparoscopic cholecystectomy (LC) has become the procedure of choice in the surgical treatment of symptomatic biliary lithiasis. The operation is not completely risk-free, some incidents and complications being more frequent than with open cholecystectomy (OC). This study analysed the frequency of these complications and the best methods of treating them.
Materials and methods
Laparoscopic cholecystectomy (LC) was performed in 9542 (68%) of these patients, 1659 (17.4%) being men and 7883 (82.6%) women. Ages ranged between 14 and 91 years, and 732 patients were aged over 65 years. The operative diagnoses are given in Table 1. The series included two pregnant women in the second trimester of pregnancy and 3672 obese patients ( Table 2 ).