Journal of AdvancedMedical and Dental Sciences Research

A RETROSPECTIVE ANALYSIS OF COMPLICATIONS IN 2348 CASES OF LAPAROSCOPIC CHOLECYSTECTOMIES

Background: Laparoscopic cholecystectomy (LC) has become the "gold standard" surgical procedure for treating gallstones although some complications appear more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analyzed. Materials and methods: Over the duration of last eight years 2348 LCs have been performed at MAMC Agroha, out of these 258 (11%) were men and 2090 (89%) women. Ages ranged between 24 and 89 years, and 6.4% patients were aged above 65 years. Acute cholecystitis was present in 8.5% of the patients and 42.8% patients were obese. Results: The most common operative complications encountered were haemorrhage (99 cases, 4.2%), iatrogenic perforation of the gallbladder (458 cases, 19.5%) and common bile duct (CBD) injuries (6 cases, 0.3%). Conversion to open operation was necessary in 66 patients (2.8%), usually due to obscure anatomy because of acute inflammation. The main postoperative complications were bile leakage (33 cases), haemorrhage (6 cases), sub-hepatic abscess (4 cases) and retained bile duct stones (9 cases). Among patients with postoperative complications 36.5% responded to conservative treatment and 23.1% required open surgery. In 40.4% of cases minimally invasive procedures were used successfully: 6 laparoscopic re-operations (for choleperitoneum, haemoperitoneum and subhepatic abscess) and 15 endoscopic sphincterotomies (for bile leakage from the subhepatic drain and for retained CBD stones soon after operation). Three deaths were recorded (0.1%). Conclusion: Most of the postoperative complications except for the bile duct injuries were resolved by conservative or minimally invasive treatment. The good results obtained allow us to recommend these minimally invasive procedures in appropriate patients to decrease the morbidity due to copmlications of laparoscopic cholecystectomy.
Keywords: laparoscopic cholecystectomy, open cholecystectomy, complications, minimally invasive treatment of complications