According to the Society of American Gastrointestinal and Endoscopic Surgeons, cholecystectomies or gallbladder removal surgeries are among the most common surgeries done in the United States. When the gallbladder becomes inflamed and causes pain due to gallstones, a surgeon may elect to remove the gallbladder. The standard of care is to do this surgery through the laparoscope. The complication rate for laparoscopic versus an open procedure is the same when done by a trained surgeon, according to the society. Complications can include unintended injury to the small bowel, leakage of bile into the abdomen and injury to the bile ducts.
Small Bowel Injury
Because the small intestine lies directly beneath the gallbladder, it is susceptible to unintended injury. Accidental perforation with an instrument can occur. Placement of the trocars or ports used to insert instruments into the abdominal wall for the surgery can penetrate the small bowel if it is stuck up to the wall of the abdomen. Occasionally the cautery used to stop bleeding can burn the small intestine and cause perforation. When the gallbladder is inflamed, this causes a localized reaction around it and the small intestine and large intestine can be stuck on the gallbladder, making dissection particularly precarious.
Bile Duct Injury
According to the "Washington Manual of Surgery," bile duct injuries have increased to approximately 0.5% since laparoscopic cholecystectomies were initiated. During surgery the gallbladder and cystic duct must be detached from the common bile duct. This requires the surgeon to properly identify the cystic duct and place a small clip around it separating it from the common bile duct. Occasionally the bile duct or hepatic duct can be mistaken for the cystic duct and clipping this can cause occlusion of the common bile duct. The clip is important, however, as it prevents bile from refluxing back into the abdomen. Occasionally the clip can tear the duct and bile will leak. Burn injuries from the cautery can injure the common bile duct. Most injuries to the bile ducts are not recognized at the time of surgery. Postoperatively, patients with bile duct injuries present with complaints of persistent nausea and vomiting, low grade fever and vague abdominal pain, according to the "Washington Manual of Surgery."
Bile Leakage
Small fluid collections are seen around the liver by ultrasound in approximately 50 percent of patients within 24 hours of surgery, according to UpToDate. These are considered normal postoperative findings and do not cause symptoms. Patients who have fever, abdominal pain,mild jaundice and abnormal liver function blood tests two to 10 days postoperatively may have a major biliary leak. Bile leakage into the abdominal cavity can cause peritonitis or inflammation of the abdomen and this is a serious complication.
References
- Society of American Gastrointestinal and Endoscopic Surgeons: Patient Information for Laparoscopic Gallbladder Removal.
- "Washington Manual of Surgery." 3rd Ed. Gerard M. Doherty and et al. 2002
- UpToDate.com: Complications of laparoscopic cholecystectomy
