Factors leading to post-cholecystectomy bleeding requiring reoperation: A case series

Laparoscopic cholecystectomy is widely regarded as the standard treatment for symptomatic gall bladder diseases due to its minimally invasive nature and favorable recovery profile. However, hemorrhagic complications pose significant risks to patient safety and outcomes.

This retrospective case series aimed to evaluate the incidence, risk factors and outcomes associated with intraoperative and post-operative hemorrhagic complications in patients undergoing cholecystectomy. Eighteen patients who experienced significant bleeding necessitating unplanned reoperations were included in the analysis. Data were collected encompassing demographic information, comorbidities, surgical details and post-operative outcomes.

The study found that older age and higher body mass index (BMI) were strongly correlated with increased estimated blood loss, with each additional year of age increasing the odds of severe hemorrhage by 7% and each unit increase in BMI raising the odds by 15%. Patients with the American Society of Anesthesiologists classifications of 3-4 were 3.5 times more likely to experience severe bleeding. In addition, the use of anticoagulant or antiplatelet therapy was associated with a nearly six-fold increase in the risk of significant hemorrhage. The presence of adhesions or severe inflammation further doubled the risk of substantial blood loss. Hemorrhagic complications were associated with prolonged hospital stays, higher rates of blood transfusions and increased mortality.

These findings highlight the importance of pre-operative risk assessment and tailored surgical strategies to mitigate bleeding risks. Enhancing patient evaluation and optimizing surgical techniques are crucial for improving outcomes and ensuring patient safety in cholecystectomy procedures.