[Analysis of complications and clinical and pathologic factors in relation to the laparoscopic cholecystectomy]

Laparoscopic cholecystectomy (LCHCE) is connected with a different spectrum of postoperative complications than classic cholecystectomy. The aim of this study was to analyse the complications and define their relation to some chosen clinical and pathological factors and their incidence.

We included 1014 patients that were operated (laparoscopic or converted cholecystectomy) at the Department of Surgery, University Hospital in Pilsen between January 1st 2008 and December 31st 2011. All included patients were at least one year after cholecystectomy in the time of the realization of this study therefore we could analyse late complications. The group of patients included 351 men (34.6%) and 663 women (65.4%). The median age was 57 years (range: 8-87 years). We evaluated the following clinical and pathological factors: a histopathological diagnosis, early surgical and internal complications (with manifestation within 30 days after cholecystectomy) classified by the Clavien-Dindo score, incisional hernia as a late complication, conversion, perforation of the gallbladder wall, the duration of hospital stay, the age of patients and the use of drain. The results of the study were calculated with use of statistical tests: the test of population probability, the two-sample t-test, the ODDS ratio) and then were compared with published literature data.

Surgical and internal complications occurred in 138 patients (13.6%) within 30 postoperative days. The most common complication was connected with the wound - 92 patients (9.1%), then a hematoma in the gallbladder bed - 16 patients (1.6%) and a biliary leak - 16 patients (1,6%). The bile duct injury which needed a reoperation affected 3 patients (0.3%). The laparoscopic operation had to be converted in 77 cases (7.6%). Incisional hernia after the placing of trocars or in the scar after the laparotomy (in the case of conversion) occurred in 32 patients (3.16%) during one year after the cholecystectomy. The influence of the age of patients on the incidence and the spectrum of postoperative complications were proved as statistically significant. Postoperative complications were more common in the case of male gender. We found a correlation between the diagnosis and postoperative complications. Men with solitary cholecystolithiasis had more common incidence of hematoma in the gallbladder bed. A biliary leak occurred three times more often after the procedures with a gallbladder wall perforation. Three of four bile duct injuries occurred during the non-converted laparoscopic cholecystectomies.

Our study proved the influence of the age of patients, the histopathological diagnosis, conversion and the perforation of gallbladder wall on the incidence of postoperative complications after laparoscopic cholecystectomy. The incidence of bile duct injury, which is the most serious complication, in our group of patients is comparable with published literature.