A retrospectively predictive assessment of the various factors responsible for the difficult laparoscopic cholecystectomy
European Journal of Molecular & Clinical Medicine,
2020, Volume 7, Issue 10, Pages 4374-4383
AbstractBackground: Laparoscopic cholecystectomy is one of the most common surgeries performed and has replaced open cholecystectomy. Laparoscopic cholecystectomy is associated with better preservation of immune function and a reduction of the inflammatory response compared with open surgery.
Aim: to determine predictive factors for difficult laparoscopic cholecystectomy.
Material and Methods: This was a retrospectively analysed conducted in the Department of General Surgery, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 1 year. 200 patients who were diagnosed with cholelithiasis and had laparoscopic cholecystectomy were included in this study. We analysed the type and frequency of intraoperative and postoperative complications, as well as factors that increase the risk for development of complications. We noted causes and incidence of conversions and the way they resolved. We noted gender, age, body mass index (BMI), white blood cell count, and level of C-reactive protein (CRP), preoperative ultrasonographic findings, pathohistological findings of the surgically removed gallbladder, as well as their correlation with the occurrence of complications.
Results: Out of the 200 patients in the study, 135 were female (67.5%), and 65 were male (32.5%). The median age was 51.5 years, including participants that were 18 to 81 year old. There were 30 patients (15%) with intraoperative complications (IOC). The most common complications noted were: iatrogenic perforations of the gallbladder- 10 (5%), bleeding from the tissues adjacent to the gallbladder 6(3%), gallstones spilt into the peritoneal cavity 4(2%). Intraoperative bleeding from the cystic artery occurred in 1 (0.5%), bleeding from the port in 1 (0.5%) and bleeding from the ligaments of the liver in 3 patients (1.5%). The transection of the common bile duct, a major complication, occurred in only one patient (0.5%). There were 25 patients (12.5%) with postoperative complications (POC) (Table 2). The most common postoperative complications were: bleeding from the abdominal cavity more than 100 ml/24h (in 8 patients or 4%), bile leaks through the drain > 50-100 ml/24h (4 patients, or 2%). Less frequent complications were surgical wound infection (3 patients, or 1.5%), incisional hernia at the place of port (2 patients, or 1%), and intra- abdominal abscess caused by residual calculus in the abdominal cavity (1 patients, or 0.5%). In the postoperative period, one case of sub hepatic collection and 1 cases of abscess formed around retained calculi were treated by laparotomy and they subsequently resolved. Hematoma of the abdominal wall around the working port was noted in 2 patients (1%). Choledocholithiasis was noted in 1 patients (0.5%), and this was resolved by endoscopic papillotomy. Both IOC and POC were more common in males compared to females, and this difference was cstatistically significant ( 2 = 0.612, p < 0.01). There were 17 conversions (8.5%), and they were more common in males (13 males, 6.5%) compared to females (4 females, or 2%). This difference was calso statistically significant ( 2 = 6.745, p<0.05).
Conclusion: The laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay.
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