Advertisement

Complications: How to Prevent and Manage Them

  • Piero NarilliEmail author
  • Annalisa Di Filippo
  • Mario Campli
  • Michele Motter
  • Alessandro Carrara
Chapter

Abstract

Biliary duct injuries and hemorrhages are still the most common complications of laparoscopic cholecystectomy. Despite the advances in surgical technique, the incidence rate of these complications is slightly higher compared with open cholecystectomy. Understanding the mechanisms of injury and a greater attention in the prevention of these damages are recommended. We performed a systematic review of the literature with the aim to bring up to date the previous EAES guidelines, paying special attention to biliary duct and vascular injuries prevention and management, but not forgetting abscesses (due to bile leaks and/or gallstone spillage) and bowel injuries. The level of evidence of each article was graded following the “Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence.”

Keywords

Laparoscopic Cholecystectomy Acute Cholecystitis Common Bile Duct Stone Bile Duct Injury Bowel Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Nuzzo G, Giuliante F, Giovannini I et al (2005) Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. Arch Surg 140:986–992PubMedCrossRefGoogle Scholar
  2. 2.
    Gigot J, Etienne J, Aerts R et al (1997) The dramatic reality of biliary tract injury during laparoscopic cholecystectomy: an anonymous multicenter Belgian survey of 65 patients. Surg Endosc 11:1171–1178PubMedCrossRefGoogle Scholar
  3. 3.
    Wherry DC, Marohn MR, Malanoski MP et al (1996) An external audit of laparoscopic cholecystectomy in the steady state performed in medical treatment facilities of the Department of Defense. Ann Surg 224:145–154PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Richardson MC, Bell G, Fullarton GM (1996) Incidence and nature of bile duct injuries following laparoscopic cholecystectomy: an audit of 5913 cases. Br J Surg 83:1356–1360PubMedCrossRefGoogle Scholar
  5. 5.
    MacFadyen BV, Vecchio R, Ricardo AE, Mathis CR (1998) Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc 12:315–321PubMedCrossRefGoogle Scholar
  6. 6.
    Z’graggen K, Wehrli H, Metzger A, Buehler M, Frei E, Klaiber C (1998) Swiss Association of Laparoscopic and Thoracoscopic Surgery. Complications of laparoscopic cholecystectomy in Switzerland: a prospective 3-year study of 10,174 patients. Surg Endosc 12:1303–1310PubMedCrossRefGoogle Scholar
  7. 7.
    Adamsen S, Hart Hansen O, Funch-Jensen P et al (1997) Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg 184:571–578PubMedGoogle Scholar
  8. 8.
    Karvonen J, Gullichsen R, Laine S et al (2007) Bile duct injuries during laparoscopic cholecystectomy: primary and long-term results from a single institution. Surg Endosc 21:1069–1073PubMedCrossRefGoogle Scholar
  9. 9.
    Söderlund C, Frozanpor F, Linder S (2005) Bile duct injuries at laparoscopic cholecystectomy: a single-institution prospective study. Acute cholecystitis indicates an increased risk. World J Surg 29:987–993PubMedCrossRefGoogle Scholar
  10. 10.
    Chuang KI, Corley D, Postlethwaite DA, Merchant M, Harris HW (2012) Does increased experience with laparoscopic cholecystectomy yield more complex bile duct injuries? Am J Surg 203:480–487PubMedCrossRefGoogle Scholar
  11. 11.
    Russell JC, Walsh SJ, Mattie AS et al (1996) Bile duct injuries, 1989–1993: a statewide experience. Arch Surg 131:382–388PubMedCrossRefGoogle Scholar
  12. 12.
    Flum DR, Koepsell T, Heagerty P, Sinanan M, Dellinger EP (2001) Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error? Arch Surg 136:1287–1289PubMedCrossRefGoogle Scholar
  13. 13.
    Waage A, Nilsson M (2006) Iatrogenic bile duct injury: a population-based study of 152 776 cholecystectomies in the Swedish inpatient registry. Arch Surg 141:1207–1213PubMedCrossRefGoogle Scholar
  14. 14.
    Törnqvist B, Strömberg C, Persson G, Nilsson M (2012) Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ. doi: 10.1136/bmj.e6457 PubMedCentralPubMedGoogle Scholar
  15. 15.
    Flum DR, Cheadle A, Prela C et al (2003) Bile duct injury during cholecystectomy and survival in Medicare beneficiaries. JAMA 290(16):2168–2173PubMedCrossRefGoogle Scholar
  16. 16.
    Way LW, Stewart LM, Gantert WM et al (2003) Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 237(4):460–469 [article]PubMedCentralPubMedGoogle Scholar
  17. 17.
    Sajid MS, Leaver C, Haider Z, Worthington T, Karanjia N, Singh KK (2012) Routine on-table cholangiography during cholecystectomy: a systematic review. Ann R Coll Surg Engl 94(6):375–380PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Hashimoto M, Matsuda M, Watanabe G (2010) Intraoperative ultrasonography for reducing bile duct injury during laparoscopic cholecystectomy. Hepatogastroenterology 57(101):706–709PubMedGoogle Scholar
  19. 19.
    Machi J, Oishi AJ, Tajiri T, Murayama KM, Furumoto NL, Oishi RH (2007) Routine laparoscopic ultrasound can significantly reduce the need for selective intraoperative cholangiography during cholecystectomy. Surg Endosc 21(2):270–274PubMedCrossRefGoogle Scholar
  20. 20.
    Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125PubMedGoogle Scholar
  21. 21.
    Eikermann M, Siegel R, Broeders I, Dziri C, Fingerhut A, Gutt C, Jaschinski T, Nassar A, Paganini AM, Pieper D, Targarona E, Schrewe M, Shamiyeh A, Strik M, Neugebauer EA (2012) Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 26(11):3003–3039PubMedCrossRefGoogle Scholar
  22. 22.
    Lengyel BI, Azagury D, Varban O, Panizales MT, Steinberg J, Brooks DC, Ashley SW, Tavakkolizadeh A (2012) Laparoscopic cholecystectomy after a quarter century: why do we still convert? Surg Endosc 26(2):508–513PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Lengyel B, Panizales MT, Steinberg J, Ashley SW, Tavakkoli A (2012) A laparoscopic cholecystectomy: what is the price of conversion? Surgery 152(2):173–178PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Livingston EH, Rege RV (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188:205–211PubMedCrossRefGoogle Scholar
  25. 25.
    Henneman D, da Costa DW, Vrouenraets BC, van Wagensveld BA, Lagarde SM (2013) Laparoscopic partial cholecystectomy for the difficult gallbladder: a systematic review. Surg Endosc 27:351–358PubMedCrossRefGoogle Scholar
  26. 26.
    Davis B, Castaneda G, Lopez J (2012) Subtotal cholecystectomy versus total cholecystectomy in complicated cholecystitis. Am Surg 78(7):814–817PubMedGoogle Scholar
  27. 27.
    Pekolj J, Alvarez FA, Palavecino M, Sánchez Clariá R, Mazza O, de Santibañes E (2013) Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center. J Am Coll Surg 216(5):894–901PubMedCrossRefGoogle Scholar
  28. 28.
    Sicklick JK, Camp MS, Lillemoe KD et al (2005) Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg 241:786–792PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Sahajpal AK, Chow SC, Dixon E, Greig PD, Gallinger S, Wei AC (2010) Bile duct injuries associated with laparoscopic cholecystectomy. Timing of repair and long-term outcomes. Arch Surg 145(8):757–763PubMedCrossRefGoogle Scholar
  30. 30.
    Barauskas G, Paškauskas S, Dambrauskas Z, Gulbinas A, Pundzius J (2012) Referral pattern, management, and long-term results of laparoscopic bile duct injuries: a case series of 44 patients. Medicina (Kaunas) 48(3):138–144Google Scholar
  31. 31.
    Fiocca F, Salvatori FM, Fanelli F, Bruni A, Ceci V, Corona M, Donatelli G (2011) Complete transection of the main bile duct: minimally invasive treatment with an endoscopic-radiologic rendezvous. Gastrointest Endosc 74(6):1393–1398PubMedCrossRefGoogle Scholar
  32. 32.
    de Reuver PR, Rauws EA, Bruno MJ et al (2007) Survival in bile duct injury patients after laparoscopic cholecystectomy: a multidisciplinary approach of gastroenterologists, radiologists, and surgeons. Surgery 142:1–9PubMedCrossRefGoogle Scholar
  33. 33.
    Thompson CM, Saad NE, Quazi RR, Darcy MD, Picus DD, Menias CO (2013) Management of iatrogenic bile duct injuries: role of the interventional radiologist. Radiographics 33(1):117–134PubMedCrossRefGoogle Scholar
  34. 34.
    Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC (1993) Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,704 cases. Am J Surg 165:9–14PubMedCrossRefGoogle Scholar
  35. 35.
    Khalid M, Rashid M (2009) Gallstone abscess: a delayed complication of spilled gallstone after laparoscopic cholecystectomy. Emerg Radiol 16(3):127–129CrossRefGoogle Scholar
  36. 36.
    Zamir G, Lyass S, Pertsemlidis D, Katz B (1999) The fate of the dropped gallstones during laparoscopic cholecystectomy. Surg Endosc 13:68–70PubMedCrossRefGoogle Scholar
  37. 37.
    Viera FT, Armellini E, Rosa L, Ravetta V, Alessiani M, Dionigi P, Rossi S (2006) Abdominal spilled stones: ultrasound findings. Abdom Imaging 31(5):564–567PubMedCrossRefGoogle Scholar
  38. 38.
    Bhati CS, Tamijmarane A, Bramhall SR (2006) Tale of three spilled gall stones: one liver mass and two abscesses. Dig Surg 23:198–200PubMedCrossRefGoogle Scholar
  39. 39.
    Iannitti DA, Varker KA, Zaydfudim V, McKee J (2006) Subphrenic and pleural abscess due to spilled gallstones. JSLS 10(1):101–104PubMedCentralPubMedGoogle Scholar
  40. 40.
    Roberts DJ, Chun HM (2005) Dropped gallstone as a nidus of intra-abdominal abscess complicated by empyema. Clin Infect Dis 41(6):e64–e66PubMedCrossRefGoogle Scholar
  41. 41.
    Hussain MI, Al-Akeely MH, Alam MK, Al-Abood FM (2010) Abdominal wall abscess following laparoscopic cholecystectomy: an unusual late complication of lost gallstones. J Coll Physicians Surg Pak 20(11):763–765PubMedGoogle Scholar
  42. 42.
    Kochar K, Vallance K, Mathew G, Jadhav V (2008) Intrahepatic perforation of the gallbladder presenting as liver abscess: case report, review of literature and Niemeier’s classification. Eur J Gastroenterol Hepatol 20(3):240–244PubMedCrossRefGoogle Scholar
  43. 43.
    Schäfer M, Suter C, Klaiber C, Wehrli H, Frei E, Krähenbühl L (1998) Spilled gallstones after laparoscopic cholecystectomy. A relevant problem? A retrospective analysis of 10174 laparoscopic cholecystectomies. Surg Endosc 12(4):305–309PubMedCrossRefGoogle Scholar
  44. 44.
    Memon MA, Deeik RK, Maffi TR, Fitzgibbons RJ Jr (1999) The outcome of unretrieved gallstones in the peritoneal cavity during laparoscopic cholecystectomy. Surg Endosc 13(9):848–857PubMedCrossRefGoogle Scholar
  45. 45.
    Tumer AR, Yüksek YN, Yasti AC, Gözalan U, Kama NA (2005) Dropped gallstones during laparoscopic cholecystectomy: the consequences. World J Surg 29(4):437–440PubMedCrossRefGoogle Scholar
  46. 46.
    Brockmann JG, Kocher T, Senninger NJ, Schurmann GM (2002) Complications due to gallstones lost during laparoscopic cholecystectomy. An analysis of incidence, clinical course, and management. Surg Endosc 16:1226–1232PubMedCrossRefGoogle Scholar
  47. 47.
    Singh K, Wang ML, Ofori E, Widmann W, Alemi A, Nakaska M (2012) Gallstone abscess as a result of dropped gallstones during laparoscopic cholecystectomy. Int J Surg Case Rep 3(12):611–613PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Woodfield JC, Rodgers M, Windsor JA (2004) Peritoneal gallstones following laparoscopic cholecystectomy. Surg Endosc 18(8):1200–1207PubMedCrossRefGoogle Scholar
  49. 49.
    Zehetner J, Shamiyeh A, Wayand W (2007) Lost gallstones in laparoscopic cholecystectomy: all possible complications. Am J Surg 193:73–78PubMedCrossRefGoogle Scholar
  50. 50.
    Rice DC, Memon MA, Jamison RL, Agnessi T, Ilstrup D, Bannon MB, Farnell MB, Grant CS, Sarr MG, Thompson GB, van Heerden JA, Zietlow SP, Donohue JH (1997) Long-term consequences of intraoperative spillage of bile and gallstones during laparoscopic cholecystectomy. J Gastrointest Surg 1(1):85–91PubMedCrossRefGoogle Scholar
  51. 51.
    Sanabria A, Dominguez LC, Valdivieso E, Gomez G (2010) Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst Rev (12):CD005265Google Scholar
  52. 52.
    Guzmán-Valdivia G (2008) Routine administration of antibiotics to patients suffering accidental gallbladder perforation during laparoscopic cholecystectomy is not necessary. Surg Laparosc Endosc Percutan Tech 18(6):547–550PubMedCrossRefGoogle Scholar
  53. 53.
    Schafer M, Lauper M, Krahenbuhl L (2000) A nation’s experience of bleeding complications during laparoscopy. Am J Surg 180:73–77PubMedCrossRefGoogle Scholar
  54. 54.
    Shamiyeh A, Wayand W (2004) Laparoscopic cholecystectomy: early and late complications and their treatment. Langenbecks Arch Surg 389:164–171PubMedCrossRefGoogle Scholar
  55. 55.
    Tzovaras G, Dervenis C (2006) Vascular injuries in laparoscopic cholecystectomy: an underestimated problem. Dig Surg 23:370–374PubMedCrossRefGoogle Scholar
  56. 56.
    Ball CG, MacLean AR, Kirkpatrick AW, Bathe OF, Sutherland F, Debru E, Dixon E (2006) Hepatic vein injury during laparoscopic cholecystectomy: the unappreciated proximity of the middle hepatic vein to the gallbladder bed. J Gastrointest Surg 10:1151–1155PubMedCrossRefGoogle Scholar
  57. 57.
    Strasberg SM, Helton WS (2011) An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy. HPB (Oxford) 13:1–14CrossRefGoogle Scholar
  58. 58.
    Pulitanò C, Parks RW, Ireland H, Wigmore SJ, Garden OJ (2011) Impact of concomitant arterial injury on the outcome of laparoscopic bile duct injury. Am J Surg 201(2):238–244PubMedCrossRefGoogle Scholar
  59. 59.
    Berti S, Bianco A, D’Ambra L, Bianchi C, Bonfante P, Falco E (2008) An easy way to control liver bed hemorrhages during laparoscopic cholecystectomies. J Am Coll Surg 206(3):1225–1226PubMedCrossRefGoogle Scholar
  60. 60.
    Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Staroscik RN, Schwartz JS, Williams SV (1996) Mortality and complications associated with laparoscopic cholecystectomy. A meta-analysis. Ann Surg 224:609–620PubMedCentralPubMedCrossRefGoogle Scholar
  61. 61.
    Shibuya K, Midorikawa Y, Mushiake H, Watanabe M, Yamakawa T, Sugiyama Y (2010) Ruptured hepatic subcapsular hematoma following laparoscopic cholecystectomy: report of a case. Biosci Trends 4(6):355–358PubMedGoogle Scholar
  62. 62.
    Puggioni A, Wong LL (2003) A meta-analysis of laparoscopic cholecystectomy in patients with cirrhosis. J Am Coll Surg 197:921–926PubMedCrossRefGoogle Scholar
  63. 63.
    Misawa T, Koike M, Suzuki K, Unemura Y, Murai R, Yoshida K, Kobayashi S, Yamazaki Y (1999) Ultrasonographic assessment of the risk of injury to branches of the middle hepatic vein during laparoscopic cholecystectomy. Am J Surg 178:418–421PubMedCrossRefGoogle Scholar
  64. 64.
    Shen BY, Li HW, Chen M, Zheng MH, Zang L, Jiang SM, Li JW, Jiang Y (2003) Color doppler ultrasonographic of the risk of injury to major branch of the middle hepatic vein during laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int 2:126–130PubMedGoogle Scholar
  65. 65.
    Bergamaschi R, Ignjatovic D (1999) Anatomic rationale for arterial bleeding from the liver bed during and/or after laparoscopic cholecystectomy: a postmortem study. Surg Laparosc Endosc Percutan Tech 9:267–270PubMedCrossRefGoogle Scholar
  66. 66.
    Stewart L, Robinson TN, Lee CM et al (2004) Right hepatic injury associated with laparoscopic bile duct injury: incidence, mechanism and consequences. J Gastrointest Surg 8:523–531PubMedCrossRefGoogle Scholar
  67. 67.
    Alves A, Farges O, Nicolet J et al (2003) Incidence and consequence of an hepatic artery injury in patients with postcholecystectomy bile duct strictures. Ann Surg 238:93–96PubMedCentralPubMedGoogle Scholar
  68. 68.
    Chen TH, Shyu JF, Chen CH, Ma KH, Wu CW, Lui WY, Liu JC (2000) Variations of the cystic artery in Chinese adults. Surg Laparosc Endosc Percutan Tech 10:154–157PubMedGoogle Scholar
  69. 69.
    Gray S, Skandalakis J (1985) Atlas of surgical anatomy for general surgeons. Williams & Wilkins, BaltimoreGoogle Scholar
  70. 70.
    Rosemberg J, Leinskold T (2004) Dome down laparoscopic cholecystectomy. Scand J Surg 93:48–51Google Scholar
  71. 71.
    Strasberg SM (2008) Error traps and vasculo-biliary injury in laparoscopic and open cholecystectomy. J Hepatobiliary Pancreat Surg 15:284–292PubMedCrossRefGoogle Scholar
  72. 72.
    Binenbaum SJ, Goldfarb MA (2006) Inadvertent enterotomy in minimally invasive abdominal surgery. JSLS 10(3):336–340PubMedCentralPubMedGoogle Scholar
  73. 73.
    Azevedo JLMC, Azevedo OC, Miyahira SA, Miguel GPS, Becker OM Jr, Hypolito OHM, Machado ACCG, Cardia W, Yamaguchi GA, Godinho L, Freire D, Almeida CES, Moreira CH, Freire DF (2009) Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc 23:1428–1432PubMedCrossRefGoogle Scholar
  74. 74.
    Taylor AM, Li MKW (1994) Laparoscopic management of complications following laparoscopic cholecystectomy. Aust N Z J Surg 64:827–829PubMedCrossRefGoogle Scholar
  75. 75.
    Flowers JL, Zucker KA, Bailey RW (1994) Complications. In: Ballantyne GH, Leahy PF, Modlin IM (eds) Laparoscopic surgery. WB Saunders, Philadelphia, pp 77–94, chapter 8Google Scholar
  76. 76.
    Triantafyllidis I, Nikoloudis N, Sapidis N, Chrissidou M, Kalaitsidou I, Chrissidis T (2009) Complications of laparoscopic cholecystectomy: our experience in a district general hospital. Surg Laparosc Endosc Percutan Tech 19(6):449–458PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Piero Narilli
    • 1
    Email author
  • Annalisa Di Filippo
    • 2
  • Mario Campli
    • 3
  • Michele Motter
    • 4
  • Alessandro Carrara
    • 4
  1. 1.Division of Surgery“Nuova Itor” Private Health FacilityRomeItaly
  2. 2.Division of Surgery“Nuova Itor” Private Health FacilityRomeItaly
  3. 3.Division of Surgery“Nuova Itor” Private Health FacilityRomeItaly
  4. 4.1st Division of Surgery“Santa Chiara” HospitalTrentoItaly

Personalised recommendations