Biliary Complications Post Laparoscopic Cholecystectomy: Mechanism, Preventive Measures, and Approach to Management: A Review

Abstract

Laparoscopic cholecystectomy has emerged as a gold standard therapeutic option for the management of symptomatic cholelithiasis. However, adaptation of LC is associated with increased risk of complications, particularly bile duct injury ranging from 0.3 to 0.6%. Occurrence of BDI results in difficult reconstruction, prolonged hospitalization, and high risk of long-term complications. Therefore, more emphasis is placed on preventing these complications. In addition to adequate training, several techniques have been proposed to prevent bile duct injury including use of 30° scope, adequate delineation of structures in Calot's triangle (critical view), avoidance of diathermy close to common hepatic duct, and intraoperative cholangiogram, and to maintain a low threshold to conversion to open approach when uncertain. Management of Bile duct injury depends on the nature of injury, time of detection, and the expertise available, and would range from simple subhepatic drainage to Roux-en-Y hepaticojejunostomy particularly performed at specialised centers. This article based on the literature review aims to review the biliary complications following laparoscopic cholecystectomy with reference to its mechanism , preventive measures to be taken, and the management approach.

Hepatic or Cystic Artery Pseudoaneurysms Following a Laparoscopic Cholecystectomy: Literature review of aetiopathogenesis, presentation, diagnosis and management

“…1,2 However, it is rarely associated with major complications, such as vascular complications (0.25%).…”

Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

“…Najbolj neugoden zaplet pri holecistektomiji je poškodba žolčnih vodov, ki povzroči biliarno fistulo. Oneil Manchado je v svoji metaanalizi ugotavljal, da pride do poškodbe žolčnih vodov pri 0,3-0,6 % vseh laparoskopskih holecistektomij (34). Duca in sodelavci so opravili retrospektivno analizo 9.542 bolnikov po laparoskopski holecistektomiji (35).…”

Porcelain Gallbladder: Decoding the malignant truth

“…9 In most patients, the risk of cholecystectomyrelated complications is relatively low, with major complications occurring in 3-4% of cases, including perioperative mortality and common bile duct injuries (0.5% each). 2,27 However, the risk may be significantly higher in patients with adverse gallbladder conditions, such as recurrent inflammation or cirrhosis, or in individuals with significant comorbidities, particularly those of a cardiac or respiratory nature. 27,28 In a recent report, perioperative complications following a cholecystectomy in patients with PGB varied based on the presence of symptoms prior to the surgery; the rate of complications was 10.7% among those who were asymptomatic and 16.7% among those who were symptomatic.…”

“…2,27 However, the risk may be significantly higher in patients with adverse gallbladder conditions, such as recurrent inflammation or cirrhosis, or in individuals with significant comorbidities, particularly those of a cardiac or respiratory nature. 27,28 In a recent report, perioperative complications following a cholecystectomy in patients with PGB varied based on the presence of symptoms prior to the surgery; the rate of complications was 10.7% among those who were asymptomatic and 16.7% among those who were symptomatic. 15 Moreover, complications led to eight endoscopic or percutaneous interventions and five additional surgeries.…”