Related Experiment Video
Updated: Feb 3, 2026
Ischemia-reperfusion Model of Acute Kidney Injury and Post Injury Fibrosis in Mice
Published on: August 9, 2013
Management of post cholecystectomy vascular injuries
Vishal Gupta1, Vivek Gupta1, Pradeep Joshi1
1Department of Surgical Gastroenterology, King George's Medical University, Lucknow, 226003, Uttar Pradesh, India.
Insights
Vascular injuries during cholecystectomy are rare but serious complications. Prompt diagnosis and management at a specialized center are crucial to reduce patient morbidity and mortality from these surgical errors.
Area of Science:
- Surgical Gastroenterology
- Vascular Surgery
- Hepatobiliary Surgery
Background:
- Cholecystectomy can lead to severe vascular and vasculobiliary injuries.
- These complications necessitate complex surgical interventions and increase patient morbidity and mortality.
Observation:
- A retrospective review of 117 patients with cholecystectomy complications identified 6 cases (5.1%) of vascular injury.
- Combined vasculobiliary injury occurred in 3.4%, and isolated vascular injury in 1.7%.
- Portal vein and right hepatic artery injuries were equally prevalent (3 cases each).
Findings:
- Vascular injuries were more common in open cholecystectomies.
- Diagnosis timing varied, with some identified intraoperatively and others weeks later.
- Biliary injuries manifested as bile leaks, with definitive repair in only one patient.
- One mortality was recorded in the series.
Implications:
- Vascular injury is an uncommon but potentially catastrophic complication of cholecystectomy.
- Prevention requires adequate surgeon training, awareness of aberrant anatomy, and meticulous surgical technique.
- Timely referral to a tertiary center is vital for optimal management and reduced litigation.
Introduction:
Vasculobiliary and vascular injuries following cholecystectomy are the most serious complications requiring complex surgical management resulting in greater patient morbidity and mortality.
Methodology:
The study was performed at a tertiary teaching hospital of North India. Records of patients referred for biliary or vascular injury sustained during cholecystectomy were reviewed retrospectively to identify patients with vascular injury between January 2009 and March 2018. Clinical profile, hospital course and outcome of these patients were analysed.
Results:
Over nine years, 117 patients were referred for cholecystectomy related complications. Total incidence of vascular injury was 5.1% (6/117). Combined vasculobiliary injury (VBI) occurred in 3.4% (4/117) while isolated vascular injury was present in 1.7% patients (2/117). Most (5/6) patients were operated for uncomplicated gall stone disease. Incidences of portal vein (PV) and right hepatic artery (RHA) injuries were equal (3/6). PV injuries were repaired either during cholecystectomy (1/3) or during re-exploration after damage control packing (2/3). RHA injuries presented as pseudoaneurysm and were managed surgically (2/3) or by coil embolization (1/3). All VBI referrals (4/117) were following open cholecystectomy. In VBI patients, vascular injury was diagnosed intra-operatively in two while it was diagnosed several weeks after cholecystectomy in two others. Biliary injury manifested as bile leak post-operatively in all four of them. Nature of biliary injury could be characterized in only 50% (2/4) patients. Definitive repair of biliary injury was performed in one patient only. There was one mortality in our series.
Conclusion:
Vascular injury is an uncommon complication of cholecystectomy with catastrophic outcome if not managed timely and properly. Adequate surgeon training, keeping the possibility of aberrant vasculobiliary anatomy in all cases, and proper surgical technique is crucial for prevention of such injuries. However in such an event, proper documentation and referral to tertiary centre will help in decreasing morbidity and further litigation.
Related Concept Videos
01:22Acute Kidney Injury VI: Nursing Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
03:24Seedless Vascular Plants
01:16Vascular Spasm
01:20Overview of the Vascular System
01:20Vascular Resistance
The primary determinants of vascular resistance are vessel diameter, blood viscosity, and vessel length. Among these, vessel diameter plays the most significant role due to the fourth power relationship described by...