A prospective study of different complications following laparoscopic cholecystectomy in a tertiary care hospital in Eastern India

Abstract

INTRODUCTIONLaparoscopy cholecystectomy (LC) has already become the standard of care in the management of symptomatic and (in selected cases) asymptomatic cholelithiasis.1,2 The proven advantages of laparoscopic approach over open approach includes less post-operative pain, decreased hospital stay, earlier recovery, better cosmesis and costeffectiveness amongst others.3 With the increasing use of LC, the spectrum of associated complications is also changing. With the increasing experience of the operating surgeon, the severe complications like bile leak, bowel injury and vascular injury are expected to decrease. 4This prospective observational study analyses the incidences of complications of LC in a tertiary care centre in eastern India and compares them to those in already published data. ABSTRACTBackground: Laparoscopic approach for cholecystectomy has already become the standard of care for the management of symptomatic and (in selected cases) asymptomatic cholelithiasis. Despite proven advantages laparoscopic cholecystectomy (LC) is known to be associated with certain complications. Methods: This prospective study was undertaken to document the incidences of such complications and to compare them to those in already published data. A total of 750 cases of LC performed in the department of general surgery at IPGME and R and SSKM hospital, Kolkata were observed for a minimum period of 8 weeks following surgery. The complications were noted and their incidences calculated using simple statistical tools. These were then compared with those in already published data. Results: A total of 493 complications occurred in 483 patients (64.4%). The most common complication was port-site infection (PSI) occurring in 476 patients (63.5%). The other complications included bleeding (1.2%), bowel injury (0.7%) and bile duct injury (0.4%). Mortality occurred in 3 cases (0.4%). Conversions to open cholecystectomy (OC) due to inability to proceed in a timely manner because of difficult exposure or unclear anatomy were not considered as complications rather as an inevitable extension of the primary approach in some difficult scenarios. Conclusions: At the end of our study period we could conclude that the incidences of specific complications in our study are less than those reported from different centres across the globe except for PSI. The alarmingly high incidence of PSI noted is a matter for introspection. A detailed study needs to be undertaken so that appropriate measures may be taken to prevent this scourge.

Laparoscopic cholecystectomy for gallbladder stone disease:preoperative factors associated with difficult operations

“…Laparoscopic cholecystectomy has become the treatment of choice for symptomatic cholelithiasis [17], because it has several physiological advantages over open cholecystectomy, such as less post operative pain, faster return of bowel function, shorter hospital stay. It can be carried out with reduced morbidity and mortality [1,2,6,7,8] . Indeed, it is considered to be the most common laparoscopic procedure in general surgery [12].…”