EARLY COMPLICATIONS FOLLOWOING LAPAROSCOPIC CHOLECYSTECTOMY IN BASRAH GENERAL HOSPITAL
Abstract
Background: Gall stone disease is one of the commonly encountered diseases among the general population. Laparoscopic cholecystectomy has been replaced open surgery and it is now considered the "golden standard". Numerous complications might be encountered. Objectives: To assess and evaluate the specific early postoperative complications and its management and to assess the factors that might influence the development of such complication. Patients and methods: A prospective consecutive observational study was conducted in Basrah General Teaching Hospital from January 2011 to December 2011. All adult patients with symptomatic gall stone were included in this study. The entire demographic, preoperative, operative and postoperative patient's data were collected and evaluated. Results: A 546 patients were underwent laparoscopic cholecystectomy during the study period, 454(83.2%) were female and 92(16.8%) were males. The mean age were 40 years+/- 13.7. Gall bladder perforation with bile leak(with or without gall stone spillage) was the commonest intraoperative complication that occurred in 49(8.97%) patients. Intraoperative bleeding reported in 26(4.76%) patients. Intraoperative bile leak reported in 2(0.36%) patients. The conversion rate was 4.76% (26 patients).The commonest postoperative complication was wound related complication, which was reported in 13 (2.38%) patients. Using logistic regression analysis, we found that the age < 60years, male sex , acute gall bladder status, operation time < 60 min and usage of drain were influenced the development of intraoperative complication on the other hand all the factors failed to affect the development of postoperative complication.References
Portincasa P, Stolk MF, van Erpecum KJ, Palasciano G, van Berge-Henegouwen GP. Cholesterol gallstone formation in man and potential treatment of the gallbladder motility defect. Scand J GastroenterolSuppl 1995; 212: 63-78.
Perissat J. Laparoscopic Cholecystectomy: the European experience. Am J Surg 1993; 165: 444-9.
Ros A, Carlsson P, Rahmqvist M, Bachman K, Nilsson E. Nonrandomized patients in a cholecystectomy trial: characteristics, procedure, and outcomes. BMC Surgery 2006;6:17.
Hobbs MS, Mai Q, Knuimam MW, et al. Surgeon experienceand trends in intraoperative complications in laparoscopic cholecystectomy. BJS 2006;93;844-53.
Deziel DJ, Millikan KW, Economou SG, DoolasA, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy. A national survey of 4292 hospitals and an analysis of 77604 cases. Am J of Surg 1993.165: 9-14.
Sari YS, Tunali V, Tomaoglu K, Karagoz B, Guneyi A, Karagoz I. Can bile duct injuries be prevented? A new technique in laparpscopic cholecystectomy. BMC Surgery. 2005: 5-14.
Mir IS, Mohsin M, Kirmani O, Majid T, Wani K, Hassan MU, et al. Is intraoperative cholangiography necessary during Laparoscopic cholecystectomy? A multicentre rural experience from a developing world country. World J Gastroenterol 2007;13:4493-7.
G. Marakis, T.E. Pavlidis, E. Aimoniotou, K. Ballas, K. Psarras, D. Karvounaris, S. Rafailidis, H. Demertzidis& A. Sakantamis: Major Complications During Laparoscopic Cholecystectomy. The Internet Journal of Surgery.2006 Volume 8 Number.
Bonjer HJ, Hazebroek EJ, Kazemier G, Giuffrida MC, Meijer WS, Lange JF.Review. Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg 1997; 84: 599-602.
Schafer M,Suter C, Klaiber C, et al. Spilled gallstones after laparoscopic cholecystectomy. A relevant problem?A retrospective analysis of 10,174 laparoscopic cholecystectomies. Surg Endosc1998;12:291–3.
Rice DC, Memon MA, Jamison RL, et al. Long term consequences of intraoperative spillage of bile and gall stones during laparoscopic cholecystectomy. J Gastrointest Surg1997;1:85–91.
T Sathesh-Kumar,A P Saklani,R Vinayagam,R L Blackett4. Spilled gall stones during laparoscopic cholecystectomy: a review of the literature. Postgrad Med J 2004;80:77-79.
Jorgzehetner, Andreas Shamiyeh,and Wolfgang Wayand. Lost gallstones in laparoscopic cholecystectomy: all possible complications. The Am J Surg 193 (2007): 73–78.
Horton M, Florence MG. Unusual abscess patterns following dropped gallstones during laparoscopic cholecystectomy. Am J Surg1998;175:375–9.
Rooh-ul-Muqim, Qutab-e-Alam Jan, Mohammad Zarin, Mehmud Aurangzaib, Aziz Wazir.Complications of Laparoscopic Cholecystectomy. World Journal of Laparoscopic Surgery, January-April 2008,1(1):1-5.
Mases A, Montes A, Ramos R, Trillo L, Puig MM. Injury to the abdominal aorta during laparoscopic surgery: an unusual presentation. Anesth Analg. 2000; 91:561-2.
Phillips PA, Amaral JF. Abdominal access complications in laparoscopic surgery. J Am Coll Surg. 2001; 192:525-36.
Kaushik R. Bleeding complications in laparoscopic cholecystectomy: Incidence, mechanisms, prevention and management. J Minim Access Surg. 2010; 6(3):59-65.
SK Biswas1, JC Saha2, ASMT Rahman3, ASMZ Rahman,MM Rahman5Rate of Conversion and Postoperative Complications of Laparoscopic Cholecystectomy in District Level Hospital of Bangladesh. Faridpur Med. Coll. J. 2011;6(2):74-77.
Erol DD, Polat C, San O:The diagnosis and early treatment of acute hemorrhagic shock after laparoscopic cholecystectomy; Internet J Anaesthesiol 2005.
Shamiyeh A , Wayand W: Laparoscopic cholecystectomy:early and late complications and their treatment.Langenbecks. Arch Surg (2004) 389:164–171.
S Duca, C. Iancu, O. Bãlã, N. Al-Hajjar, F. Graur, I. C. Puia, D. Munteanu. Mini-invasive Treatment of Complications Following Laparoscopic Cholecystectomy. Acta chir belg, 2004, 104, 309-312.
Frilling A, Li J, Weber F, Fruhaus NR, et al. Major bile duct injuries after laparoscopic cholecystectomy: a tertiary center experience. J Gastrointest Surg 2004;8(6):679-85.
Hunter JG, Thompson SK. Laparoscopic cholecystectomy, intraoperative cholangiography, and common bile duct exploration. In: Mastery of Surgery, 5th ed. Vol 1. Fischer, Josef E, editors. 2007. p. 116.
Ghnnam W, Malek J, Shebl E, Elbeshry T, Ibrahim A. Rate of conversion and complications of laparoscopic cholecystectomy in a tertiary care center in Saudi Arabia. Ann Saudi Med. 2010; 30(2):145-8.
Vagenas K, Karamanakos SN, Spyropoulos C, Panagiotopoulos S, Karanikolas M, Stavropoulos M. Laparoscopic cholecystectomy: A report from a single center. World J Gastroenterol 2006;12:3887-90.
Boni L, Benevento A, Rovera F, Dionigi G, et al. Infective complications in Laparoscopic surgery. Surg Infect (Larchmet)2006;7 supply 2:5109-11.
Crystine M. Lee, MD; Lygia Stewart, MD; Lawrence W. Way, MD.Postcholecystectomy Abdominal Bile Collections. Arch Surg. 2000;135:538-544.
Jendresen MB, Thoroll JE, Adamsen S, et al. Preoperative routine magnetic resonance cholangiopancreatography before laparoscopic cholecystectomy: a prospective study. Eur J Surg2002 ; 168:690 –69.
JiYeon Kim, Kyoung Won Kim, Chul-Soo Ahn, Shin Hwang, Young-Joo Lee, Yong Moon Shin and Moon-Gyu Lee. Spectrum of Biliary and Nonbiliary Complications After Laparoscopic Cholecystectomy: Radiologic Findings. Am J Radiology. 2008; 191:783-789.
Feng Yi, Jin Wen-Sheng, Xiang De-Bing, Sun Gui-Yin and Dai Huaguo. Complications of Laparoscopic Cholecystectomy and its Prevention: A Review and Experience of 400 Cases. www.hepato-gastroenterology.org. 2012; 59(113).
Lau WY, Lai EC, Lau SH: Management of bile duct injury after laparoscopic cholecystectomy: a review. ANZ J Surg 2010; 80(1-2):75-81.
Al-Salamah SM. Outcome of laparoscopic cholecystectomy in acute cholecystitis. J Coll Physicians Surg Pak 2005;15(7):400-3.
