Complications in laparoscopic cholecystectomy

Author: 
Graziano Giorgio Maria Paul and Anthony Di Cataldo

Indroduction: Laparoscopic gallbladder video surgery is considered the gold standard for cholecystectomy; But it has an ever-increasing number of iatrogenic lesions of the major biliary tract. Since in Italy they are about 100,000 a year, it is estimated that there are about 500 iatrogenic biliary lesions in the same period (0.5%). This event occurs if the risk is to be ignored by analyzing the areas where the risk may occur during the clinical-care process. The purpose of this study is to study the complications most commonly occurring during or after laparoscopic cholecystectomy surgery is to identify the causes that determine the clinical risk and to propose prevention measures.
Materials and methods: From January 2006 to December 2016 at the Department of Science Surgical Specialist Medical II II of AOU Policlinico Catania 2016 were subjected to laparoscopic 3604 cholecystectomy interventions. In consultation with the business database and the operative directors of the period indicated our study, Showed that the complications found were in n 21 (0.6%) patients. Results N 21 Conversions were performed, Bleeding n2, biliaren1 collection, major biliary pathway lesions n13, intestinal lesions n 4. 15 cases had a major biliary pathway injury; 6 of them were readily recognized at the operative site and solved by laparotomic reconversion: for 4 of them, the repair procedure provided a reconstruction on Kehr's T-tube, 2 to which a subsequent stent positioning was added; In the last case, he opted for the conversion as, without finding the common liver of liver, a liver-digiunostomy was performed on Y-Roux's lobe.
Discussion: In our experience, it is noted that the variables that particularly affect the success of laparoscopic practice were: The operator's experience Being an operator at the beginning of a surgeon who in the phase immediately after learning training has performed interventions under 50 Other causes include inefficient instrumentation and the severity of the clinical case.
Conclusions: The risk factors identified in our study that are responsible for adverse events are related to general conditions (obesity, hepatopathy, cholecystitis) or surgical procedures (laparoscopic access) or. Failure to follow simple technical rules during cholecystectomy, or the absence of intraoperative cholangiography, which minimizes biliary risk

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DOI: 
DOI: http://dx.doi.org/10.24327/ijcar.2017.3859.0382