Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic...

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.

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.