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The hidden threat of uncontrollable bleeding from the gallbladder bed during laparoscopic cholecystectomy
Gnankanesh Rajeeth1, Suchintha Tilakaratne2, Rohan Chaminda Siriwardana2
1University Surgical Unit, Teaching Hospital, Kelaniya, Sri Lanka.
Insights
Laparoscopic cholecystectomy can cause bleeding from the middle hepatic vein. Awareness of this risk and careful surgical technique are essential for patient safety during gallbladder removal.
Area of Science:
- Hepatobiliary Surgery
- Surgical Anatomy
- Minimally Invasive Procedures
Background:
- Laparoscopic cholecystectomy is standard for symptomatic gallstones.
- Intraoperative bleeding occurs in 0.9-1.9% of cases, often from the gallbladder bed.
- Middle hepatic vein injury is a significant complication.
Observation:
- Presents a case of a superficial middle hepatic vein during donor hepatectomy with cholecystectomy.
- Highlights the proximity of the middle hepatic vein to the gallbladder bed.
- Emphasizes anatomical variations and the need for surgical caution.
Findings:
- Safe Calot triangle dissection is vital to prevent bile duct and vascular injuries.
- Proximity of the middle hepatic vein to the gallbladder bed poses a risk.
- Anatomical variations necessitate heightened vigilance.
Implications:
- Careful surgical technique and anatomical awareness are crucial for laparoscopic cholecystectomy.
- Maintaining focus post-critical view is advised.
- Preoperative imaging (USS Venous Doppler, CT scan) can mitigate risks.
Introduction And Importance:
Laparoscopic cholecystectomy is the treatment for symptomatic gallstone disease. However, a potential complication during this procedure is intraoperative bleeding resulting from vascular injuries, affecting around 0.9-1.9 % of cases. The most common bleeding site is the gallbladder bed, predominantly due to bleeding from the middle hepatic vein and its major branches.
Case Presentation:
This article presents an illustrative case of a superficial middle hepatic vein encountered during cholecystectomy during a donor hepatectomy.
Clinical Discussion:
Safe dissection of the Calot triangle is crucial in cholecystectomy to prevent bile duct injuries. Attention is drawn to the proximity of middle hepatic vein to the gallbladder bed during dissection, which can lead to complication. Recent studies highlight significant anatomical variations, emphasizing the need for caution, especially in the patients with specific conditions.
Conclusion:
The careful surgical technique and awareness of anatomical variations, particularly regarding the proximity of the middle hepatic vein to the gallbladder bed during laparoscopic cholecystectomy. Surgeons are cautioned to maintain the focus throughout the procedure, even after achieving the critical view of safety. Preoperative evaluation of this anatomy with USS Venous Doppler and CT scan is minimize the risk of complications.
