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Hidden blood loss and the influencing factors after laparoscopic cholecystectomy
Ren-Rui Wan1, Yong-Li Wang2, Xiao-Chang Wu1
1Department of Hepatobiliary Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Huzhou, China.
Insights
Hidden blood loss (HBL) during laparoscopic cholecystectomy (LC) is significant, averaging 259.3 mL. Hypertension, gallbladder bed characteristics, and longer operation times are key factors influencing HBL in LC patients.
Area of Science:
- Surgical Research
- Minimally Invasive Surgery
- Patient Safety
Background:
- Perioperative hidden blood loss (HBL) during laparoscopic cholecystectomy (LC) is often underestimated.
- Understanding HBL is crucial for comprehensive patient management.
Purpose of the Study:
- To quantify HBL in LC patients.
- To identify factors influencing HBL during LC.
Main Methods:
- Prospective study of 139 LC patients (Jan 2017 - May 2019).
- HBL calculated using the Gross formula based on hematocrit and hemoglobin changes.
- Multivariate regression and ANOVA used to analyze influential factors.
Main Results:
- Mean HBL was 259.3 ± 188.5 mL.
- Gallbladder bed characteristics, hypertension, and operation time (>60 min) significantly correlated with HBL.
- No significant correlation found with sex, age, BMI, gallbladder status, liver cirrhosis, or diabetes.
Conclusions:
- HBL is a critical perioperative consideration in LC.
- Patients with hypertension, extensive gallbladder bed involvement (>50%), or prolonged operation times require closer monitoring for HBL.
Background:
A small amount of bleeding usually occurs during laparoscopic cholecystectomy (LC), but the occurrence of perioperative hidden blood loss (HBL) is ignored. So our objective is to investigate the amount of HBL and find out the influential factors in LC.
Methods:
From January 2017 to May 2019, 139 patients scheduled for LC were enrolled in the study. The data of patients' sex, age, height, weight, body mass index (BMI), form of gallbladder bed, gallbladder status, hypertension, diabetes, liver cirrhosis, drainage volume and operation time were recorded. The patients' height, weight and preoperative and postoperative haematocrit and haemoglobin were recorded and applied to the Gross formula to determine the amount of blood loss. The data of sex, age, BMI, hypertension, diabetes, gallbladder status, liver cirrhosis and operation time were analysed by multivariate linear regression analysis. One-way analysis of variance was performed to find out the relative correlation between HBL and the type of gallbladder bed.
Results:
The HBL was 259.3 ± 188.5 mL. On the basis of multivariate linear regression analysis and analysis of variance, the gallbladder bed, hypertension and the operation time are influential factors of HBL in patients with LC. However, sex, age, BMI, gallbladder status, liver cirrhosis and diabetes are not significantly correlated with HBL.
Conclusions:
HBL should not be overlooked during the perioperative period of LC, especially in patients with hypertension, gallbladder bed >50% gallbladder surface or operation time >60 min.
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