The Essence of Extra-Biliary Surgical Complications during Laparoscopic Cholecystectomy- 3 Year Observation

Abstract

Background: Laparoscopic cholecystectomy has become the treatment of choice for cholelithiasis. Biliary tract injuries are the most serious consequences of laparoscopic cholecystectomy. Extra-biliary consequences can be just as severe and inconvenient, although they have got less attention in the literature. The purpose of the study was to highlight the importance of extra biliary complications by determining their incidence, nature, and management.

Methods: This study presents a prospective analysis of extra-biliary complications occurring during 1400 laparoscopic cholecystectomies performed from January 2019 to December 2021. The study population  comprised of all the patients with symptomatic gallstone disease in whom laparoscopic cholecystectomy was done. The extra-biliary surgical  complications were divided into two distinct categories: (i) Procedure-related, and (ii) Access related in the current series.

Results: The incidence of access-related complications was 2.71 % and that of procedure-related complications was 8.21%. Port-site bleeding was repellent at times and demanded a re-do laparoscopy or conversion. Six cases of duodenal and two of colonic perforations were the major complications encountered during dissection in the area of Calot’s triangle. In 27(1.92%) patients the procedure was converted to open surgery due to different complications.

Conclusion: Laparoscopic cholecystectomy is still the gold standard treatment for cholelithiasis. Extra-biliary problems may occur during the surgery or while accessing the peritoneum. These are quite rare but can be fatal if not discovered and addressed during the operation. In tough circumstances, patience and a low threshold for conversion can significantly reduce morbidity and mortality.