COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY: AN EXPERIENCE OF 247 CASES

Authors

  • Umar Farooq Department of Surgery, Islamabad Medical and Dental College, Islamabad
  • Tariq Rashid Department of Surgery, Islamabad Medical and Dental College, Islamabad
  • Asma Naheed Department of Radiology, AI- Nafees Medical College, Islamabad
  • Najeeb Barkat Department of Surgery, Pakistan Employees Social Security Institution Hospital, Islamabad
  • Muhammad Iqbal Department of Surgery, Pakistan Employees Social Security Institution Hospital, Islamabad
  • Qamar Sultana Department of Surgery, Pakistan Employees Social Security Institution Hospital, Islamabad

Abstract

Background: Laparoscopic cholecystectomy needs lot of training and experience in developing countries like Pakistan. After the introduction of laparoscopic cholecystectomy several studies have been conducted to evaluate the complications of laparoscopic cholecystectomy and to establish the efficacy and safety of the procedure.The aim of this study was to determine the complications of laparoscopic cholecystectomy in a teaching hospital during the learning process. Methods: This descriptive case series was conducted in the department of General Surgery at Social Security Teaching Hospital, Islamabad, from October 2012 to February 2015. Patients of more than 15 years of age having symptomatic gallstones were included. Patients with dilated common bile duct (>8 mm in diameter), jaundice, acute cholecystitis, mass at porta hepatis and positive hepatitis B or C virology were excluded. Results: A sample of 247 consecutive patients was studied. Of them, 218 (88.26%) were females and 29 (11.74 %) were males. Their age ranged from 15 to 73 years (mean 43.37). Six (2.43%) patients developed epigastric port site wound infection. Four patients (1.62%) had bleeding. There was bile leakage in 2 (0.82 %) patients postoperatively. Two patients (0.82%) had collection (haematoma) in pouch of Morrison. One patient (0.41%) had duodenal injury. Eighteen (7.29 %) laparoscopic procedures were converted to open cholecystectomy. The mean postoperative hospital stay was 1.8 days. Conclusion Complication rate is high in early learning phase of laparoscopic surgery which can be reduced with proper training of surgeons and they should perform these procedures under supervision of experienced laparoscopic surgeons during their learning phase.Keywords: Laparoscopic Cholecystectomy, Complications, Laparoscopy.

References

Mouret P. From the first laparoscopic cholecystectomy to the frontiers of laparoscopic surgery: the future prospectives. Dig Surg 1991;8:124–5.

Ji W, Li LT, Li JS. Role of laparoscopic subtotal cholecystectomy in the treatment of complicated cholecystitis. Hepatobiliary Pancreat Dis Int 2006;5(4):584–9.

Ramzanali SA, Zia-ul-Islam, Shah SS. Monopolar Electrocautery versus Ultrasonic Dissection of the Gallbladder from the Gallbladder Bed in Laparoscopic Cholecystectomy. J Ayub Med Coll Abbottabad 2013;25(3-4):16–8.

Khan N, Siddiq G. Outcome of caparoscopic cholecystectomy for Gallstones disease in patients with liver cirrhosis. J Ayub Med Coll Abbottabad 2013;25(1-2):36–9.

Dalwani AG, Shaikh R, Das K, Devrajani T, Shah SZA, Shah A. Complications of Laparoscopic Cholecystectomy at Liaquat University, Jamshoro. World Appl Sci J 2013;23(6): 808–11.

Ozkardes AB, Tokac M, Dumlu EG, Bozkurt B, Ciftci AB, Yetisir F, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective, Randomized Study. Int Surg 2014;99(1):56–61.

Falor AE, de Virgilio C, Stabile BE, Kaji AH, Caton A, Kokubun BA, et al. Early laparoscopic cholecystectomy for mild gallstone pancreatitis: time for a paradigm shift. Arch Surg 2012;147(11):1031–5.

Panagiotopoulou IG, Carter N, Lewis MC, Rao S. Early laparoscopic cholecystectomy in a district general hospital: is it safe and feasible? Int J Evid Based Health 2012;10(2):112–6.

Mohammad S, Hinduja T, Fatima S. Complications of Laparoscopic Cholecystectomy in Acute Cholecystitis. J Surg Pak 2008;13(2):59–61.

Nair RJ, Dunn DC, Fowler S, McCloy RF. Progress with cholecystectomy: improving results in England and Wales. Br J Surg 1997;84(10):1396–8.

Graves HA Jr, Ballinger JF, Anderson WJ. Appraisal of Laparoscopic Cholecystectomy. Ann Surg. 1991;213(6):655–62.

Deziel DJ, Milikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: A national survey of 4,249 hospitals and an analysis of 77,604 cases. Am J Surg 1993;165(1):9–14.

Purkayastha S, Tilney HS, Georgiou P, Athanasiou T, Tekkis PP, Darzi AW. Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a meta-analysis of randomised control trials. Surg Endosc 2007;21(8):1294–300.

Pazouki A, Cheraghali R, Saeedimotahhar H, Jesmi F, Jangjoo A, Pishgahroudsari M. Pre-operative Rectal Indomethacin for Reduction of Postoperative Nausea and Vomiting after Laparoscopic Cholecystectomy: A Double-Blind Randomized Clinical Trial. J Coll Physicians Surg Pak 2015;25(1):56–9.

Mufti TS, Ahmad S, Naveed D, Akbar M, Zafar A. Laparoscopic Cholecystectomy: An Early Experience at Ayub Teaching Hospital Abbottabad. J Ayub Med Coll Abbottabad 2007;19(4):42–4.

Ishiazaki Y, Miwa K, Yoshimoto J, Sugo H, Kawasaki S. Conversion of elective laparoscopic to open cholecystectomy between 1993 and 2004. Br J Surg 2006;93(8):987–91.

Vecchio R, MacFadyen BV, Latteri S. Laparoscopic cholecystectomy: an Analysis on 114,005 cases of United States series. Int Surg 1998;83(3):215–9.

Dholia KM, Memon AA, Shaikh MS. Laparoscopic Cholecystectomy: Experience of 100 cases at a teaching hospital of Sindh. J Liaquat Univ Med Health Sci 2005;105–8.

Memon W, Khanzada TW, Samad A, Laghari MH. Complications of laparoscopic cholecystectomy at Isra University hospital, Hyderabad. Pak J Med Sci 2009;25(1):69–73.

McMohan AJ, Fullarton G, Baxter JN, O’Dwyer PJ. Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg 1995;82(3):307–13.

MacFayden BV Jr, Vecchio R, Richrdo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy. The United State xperience. Surg Endosc 1998;12(4):315–21.

Ali SA, Soomro AG, Mohammad AT, Jarwar M, Siddique AJ. Experience of Laparoscopic Cholecystectomy during a Steep Learning Curve at a University Hospital. J Ayub Med Coll Abbottabad. 2012;24(1):27–9.

Nizamuddin S, Islam AU. Factors responsible for conversion of laparoscopic cholecystectomy. Pak J Surg 2009;25(2):132-5.

Go PM, Schol F, Gouma DJ. Laparoscopic cholecystectomy in the Netherland. Br J Surg 1993;80(9):1180–3.

Chandio A, Timmons S, Majeed A, Twomey A, Aftab F. Factors Influencing the Successful Completion of Laparoscopic Cholecystectomy. JSLS 2009;13(4):581–6.

Published

2015-06-20

Most read articles by the same author(s)