Complications of Laparoscopic cholecystectomy
Discuss the complications of laparoscopic cholecystectomy?
Serious complications can occur in 2.6 percent.
A study of laparoscopic cholecystectomies reported the following types and frequencies of major complications: bleeding (0.11 to 1.97 percent), abscess (0.14 to 0.3 percent), bile leak (0.3 to 0.9 percent), biliary injury (0.26 to 0.6 percent), and bowel injury (0.14 to 0.35 percent)
Biliary leak
Major biliary leakage is usually seen 2 to 10 days postcholecystectomy. Affected patients typically present with fever, abdominal pain, and/or bilious ascites. Jaundice is usually mild. Leukocytosis and abnormal liver function tests are common. Bilirubin will be mildly elevated as the body reabsorbs third-spaced bile.
An initial USS helps to define the extent of bile leak. Bile leaks can present as localised collection or diffuse peritonitis. CT scan can define the collections better. Large loculated collections may need to be percutaneously drained by the radiologist.
MRCP offers a non-invasive method of diagnosing a bile leak, identifying the source of the leak
Significant biliary leaks can be managed by biliary stent inserted at the time of the ERCP to decrease pressure in the proximal biliary system. The stent is subsequently removed if the patient is asymptomatic and the liver function tests are normal and there is no ongoing leak at the follow-up ERCP.
Some bile duct injuries present late with biliary strictures
Bleeding complications — bleeding can occur from three distinct sites – the liver, arterial sources (cystic artery), or port insertion sites.
Bowel injury — patients may present with trocar site pain, abdominal distention or sepsis typically within 96 hours of the procedure
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