2 research outputs found
Extra-biliary complications during laparoscopic cholecystectomy: How serious is the problem?
Objective: To deteremine the incidence, nature and management of
extra-biliary complications of laparoscopic cholecystectomy. Materials
and Methods: This study presents a retrospective analysis of
extra-biliary complications occuring during 1046 laparoscopic
cholecystectomies performed from August 2003 to December 2006. The
study population included all the patients with symptomatic gallstone
disease in whom laparoscopic cholecystectomy was performed. The
extra-biliary complications were divided into two distinct categories:
(i) Procedure related and (ii) Access related. Results: The incidence
of access-related complications was 3.77% and that of procedure-related
complications was 6.02%. Port-site bleeding was troublesome at times
and demanded a re-do laparoscopy or conversion. Small bowel laceration
occurred in two patients where access was achieved by closed technique.
Five cases of duodenal and two of colonic perforations were the major
complications encountered during dissection in the area of
Calot′s triangle. In 21 (2%) patients the procedure was converted
to open surgery due to different complications. Biliary complications
occurred in 2.6% patients in the current series. Conclusion: Major
extra-biliary complications are as frequent as the biliary
complications and can be life-threatening. An early diagnosis is
critical to their management
Laparoscopic cholecystectomy in empyema of gall bladder: An experience at Liaquat University Hospital, Jamshoro, Pakistan
Objective: To find out the safety profile of laparoscopic
cholecystectomy in empyema of gallbladder. Background: Empyema of gall
bladder is a severe form of acute cholecystitis with superadded
suppuration. It has been considered a contraindication for the
laparoscopic cholecystectomy (LC) because of fear of life-threatening
complications. This study aimed to determine the safety and feasibility
of LC in empyema of gallbladder. Materials and Methods: LC was
attempted in 67 patients of empyema of gallbladder within 24h. However
in few cases there was a delay because of reluctance for surgery or
delay in giving consent etc. The procedure was performed by standard
four-port technique with few changes made to facilitate dissection
according to situation. Results: Between April 2003 to June 2006,
970 LC performed for gallstone disease at surgical unit-1 of LUMHS by
the same surgical team. Among these, 67 (6.90%) patients were diagnosed
to have empyema gall bladder. LC successfully completed in 54 (80.59%)
patients. In 13 (19.40%) patients the procedure was converted to open
cholecystectomy (OC) due to various operative difficulties of which the
most serious injuries included bleeding from cystic artery (four
cases), common bile duct injury (two cases) and duodenal injury in one
case. Maximum operating time was up to 160 minutes (one case).
Postoperative complications occurred in 10 (18.51%) successfully
operated patients. Maximum patients (n=45, 83.33%) were discharged in
48-96 hours while three patients were discharged after two weeks.
Conclusion : Laparoscopic cholecystectomy can be performed in empyema
of gallbladder keeping in mind a slightly increased risk of
complications even in the best hands. However, the experience of the
surgeon plays a key role in the overall outcome