Retrospective Analysis of Complications Associated with Laparoscopic Cholecystectomy for Symptomatic Gallstones

Abstract

IntroductionGallstones are the major cause of global morbidity. Laparoscopic approach has well-established advantages as compared to the conventional open procedure. It promises better recovery, lower morbidity, and lower postoperative pain, shortens the duration of hospital stay, and has a lower mortality rate. The aim of this study is to assess the frequency of complications in laparoscopic cholecystectomies indicated for symptomatic gallstones and also evaluate the rate of conversion.MethodsIn this retrospective analysis, all records of laparoscopic cholecystectomy, in patients of age ≥18 years, for symptomatic gallstones, from January 2015 till December 2018 in one of the largest public tertiary care hospitals in Pakistan were included.ResultsThe rate of complications associated with laparoscopic cholecystectomy was 6.8%. Older age, obesity, and multiple pre-operative risk factors were associated with complications. The most common intra-operative complication was hemorrhage (1.3%) and most common postoperative complication was surgical site infection (2.7%). Our conversion rate was 3.6%. Both intra-operative and postoperative complications were more common in procedures which were converted to open.ConclusionThe rate of complication and conversion to open in laparoscopic cholecystectomy is not very high. Older age, obesity, and multi-morbidity was associated with complications. Complicated procedures were more commonly needed to be converted to open.

Laparoscopic cholecystectomy in low income settings: Surgical and Clinical outcomes

“…A total of 56 patients were enrolled during the one-year study period of which the majority were female at 52 (92.9% In this study, no perioperative mortality was observed compared to other studies 0.7% [16],4.6% [17]. Operative morbidity was also satisfactory apart from a high rate of infection (8.9%) at the umbilical port site compared to 2.7% [18].…”

Morbimortalidad de la colecistectomía laparoscópica electiva en un servicio universitario

“…La CL es la cirugía del tracto digestivo que se practica con mayor frecuencia, por lo que es importante conocer sus riesgos y complicaciones. Estudios poblacio-nales y en particular aquellos realizados en poblaciones no seleccionadas (por ejemplo, para cirugía del día), reportan una incidencia de complicaciones asociada a CL electiva que varía entre 6,8%-7,7% (4,5) , mientras que se aproxima a 10% cuando incluyen cirugías de urgencia (8,9) . Fry y colaboradores reportan 18,7% de eventos adversos asociado a la CL electiva a 90 días de la fecha de admisión hospitalaria, los cuales incluyen estadía prolongada, readmisiones y mortalidad (10) .…”

“…No obstante, la CL no está exenta de complicaciones; si bien en su mayoría suelen ser menores, en algunos casos pueden implicar reintervenciones, readmisiones e incluso excepcional mortalidad posoperatoria (3) . La incidencia de complicaciones asociadas a CL electiva en poblaciones no seleccionadas varía entre 6,8%-7,7% (4,5) , habiéndose reportado hasta un 5% de complicaciones mayores (6) . El antecedente de enfermedad biliar complicada y la cirugía de urgencia se reportan como los principales factores para predecir riesgo de complicaciones (7) .…”

An Audit of Laparoscopic Cholecystectomy; at a Tertiary Care Hospital in Islamabad

“…6 Overall ,less surgical morbidity and mortality is reported with this procedure. 7,8 Early laparoscopic cholecystectomy is still performed by minority of surgeons for acute cholecystitis. 9 This preference was based on high risk of complications owing to local inflammation and difficulty in calot's triangle dissection in acute setting.…”