Complications of laparoscopic cholecystectomy: coordinated radiologic and surgical management in 21 patients.

Abstract

The authors describe their experience in management of bile duct injuries (n = 11), bile leaks or abscesses (n = 11), and bleeding (n = 1) as complications of laparoscopic cholecystectomy in 21 patients. Clinical presentations included jaundice, sepsis, pain, abdominal distention, and persistent gallstones. Twelve patients underwent operative cholangiography, three underwent conversion to open cholecystectomy, and 12 reoperations were performed in nine patients before interventional radiologic procedures, which included diagnostic percutaneous transhepatic cholangiography (n = 13), percutaneous biliary drainage (PBD) (n = 13), percutaneous stricture dilation (n = 3), stent insertion (n = 1), percutaneous abscess or biloma drainage (n = 19), and gallstone removal (n = 1). Each procedure was technically successful. Clinical improvement occurred in 18 of 19 patients. PBD was used as an operative guide before reconstructive surgery in two patients. Reoperation was unnecessary in 10 of 21 patients (48%). One patient died of fungal sepsis and pulmonary complications. This radiologic-surgical approach provided rapid and safe management of these complications.

Strategies for Management of Bile Duct Injury During Laparoscopic Cholecystectomy

“…Most aberrant ducts arise from the right hepatic duct and drain most commonly into the common hepatic duct or cystic duct within 30 mm of the hepatocystic angle [19][20][21][22]. In previous reports 5-17% of patients with bile duct injury had an aberrant bile duct [23][24][25], while it was 20% in our study. In two of our patients the injuries were fortunately detected intraoperatively and were immediately treated appropriately.…”

The endoscopic management of persistent bile leakage after laparoscopic cholecystectomy

“…CDL was the most frequent injury observed in our study (12 of 26 patients); they are more likely to occur when the cystic duct stump is broad, when there is scissoring of the clip, or when the surgeon cannot adequately visualize and confirm accurate clip placement at the time of operation [8]. Alternatively, leaks may simply be caused by the technical errors in clip placement, cautery use, or the assessment of the arterial anatomy [2,14,17]. Such errors can compromise cystic duct hematosis and result in necrosis and disruption, which can lead to bile leakage if the cystic duct is broad and the endoclips have not been placed across the entire stump of the cystic duct [2].…”

“…Fifteen of our patients who were treated endoscopically had similar symptoms, and two of them also had a subhepatic biloma that was aspirated percutaneously. This is the method of choice when the fluid accumulation is encapsulated [3,17]. Two patients who were treated initially by endoscopic means had additional signs of bile peritonitis and eventually underwent surgery.…”

Chirurgische Behandlung benigner Läsionen und Strikturen der Gallenwege

“…Schon beim geringsten Zweifel muss Klarheit über die Durchführung einer intraoperativen Cholangiographie erreicht werden. Ist eine Verletzung eingetreten, ist ihre Behandlung mit entsprechend breiter Expertise durch den Chirurgen und interventionellen Radiologen gemeinsam zu planen und nachhaltig durchzuführen [43] …”