[Complications in laparoscopic cholecystectomy]

For more than a century classical cholecystectomy has been a method of choice in surgical management of gallbladder diseases. At the end of eighties and at the beginning of nineties of this century, laparoscopic cholecystectomy has been introduced gradually taking the place of classical. Numerous studies deal with complications associated with this surgical procedure.

During insertion of Veress needle, injuries of the frontal abdominal wall may occur (9). Insertion of the needle into the peritoneal cavity may cause: injury of the omentum with consequential hemorrhage; intestinal and mesenteric injuries as well as injuries of urinary bladder and great blood vessels of retroperitoneum. Initial insufflation of CO2 through the needle, if it is inadequately placed, may cause subacute emphysema, intraperitoneal adhesion formation, mediastinal emphysema and pneumothorax (8-10). COMPLICATIONS RELATED TO TROCAR INSERTION--TROCAR INJURIES: Apart from injuries associated with insertion of Veress needle, insertion of trocar may cause injuries of the liver, spleen and falciform ligament (4). Trocar injuries are more severe (8,9).

Bile ducts injuries are divided into mild (injuries of a smaller bile duct, incomplete ductus cysticus occlusion or partial that is lateral injury of greater ducts) and severe (injuries of duct choledochus or hepatic ducts) (1). Bile ducts injuries are extremely severe complications with high morbidity, long-term hospitalization and may be life threatening (11,12).

Intensive and uncontrolled intraoperative bleeding, especially within the operative field, both arterial (from arterial cyst) and venous (gallbladder, vena porte) requires conversion. POSTOPERATIVE HEMORRHAGE: Postoperative hemorrhage usually occurs in cases of cystic artery damage, prolonged hemorrhage from the gallbladder, parenchymal liver injuries and as well as in open cholecystectomy it is an indication for reoperation (8,9).

Other complications, thermic and mechanic diaphragmatic injuries and infections of incisional injuries and herniations at the place of trocar insertion.

In the period June 1995-November 1997, 500 patients underwent laparoscopic cholecystectomy (401 female--80.2% and 99 male--19.8%) aging from 16-78 years of age, average age 46 years. 16 (3.2%) mild complications were recorded (reoperation was necessary in one case): 1) subcutaneous emphysema in 3 patients (0.6%) which gradually disappeared up to 36 hours after surgery; 2) Retzin's space emphysema in 1 patient (0.2%) causing dysuria for 3 days; 3) bilirea--bile excretion through subhepatic drain in 2 patients (0.4%)--from the second to seventh postoperative day (excretion did not exceed 500 ml a day) and it spontaneously stopped; 4) inflammatory hematoma of the falciform ligament (0.02%); 5) in 8 patients (1.6%) postoperative infection of infraxifoid wound was registered; 6) in 1 patient (0.2%) segmental bile duct injury occurred. Out of 500 laparoscopic cholecystectomies conversion was necessary in 19 cases (3.8%).

In spite of numerous advantages and better comfort for patients, this method may have complications, whereas incidence of bile ducts injuries seems to be higher than in the classical procedure. The more laparoscopic cholecystectomies are performed, the more bile ducts injuries occur. Out of 500 laparoscopic cholecystectomies performed at the Surgery Department of the hospital in Senta, 3.2% of mild complications were registered with 1 case needing reoperation, while in 1 case (0.2%) it was probably type A bile duct injury.