Laparoscopic gallbladder surgery, or cholecystectomy, is one of the most common surgical procedures performed in the United States, with an estimated 500,000 to 700,000 performed each year, according to "Complications in Surgery and Trauma." Using minimally invasive techniques, long instruments and cameras are inserted through small incisions in the abdomen, sparing the patient the pain and recovery time associated with the traditional larger incision. Similar to any surgical procedure, it has the associated risks of bleeding, infection and injury to surrounding structures. However, because the procedure is done laparoscopically, some complications are unique. A study published in January 2010 in "Mymensingh Medical Journal" found that complication rates can vary, and range from 5.2 percent for bleeding during the procedure to 0.12 percent for injury to the surrounding ducts and vessels.
Common Bile Duct Injury
While injury to this structure is not the most common complication, it is certainly the most devastating. During the removal of the gallbladder, the surgeon ensures that the common bile duct is not injured or divided as it is responsible for continued transport of bile from the liver to the intestine. This is difficult in patients who have abnormal anatomy and inflammation surrounding the gallbladder, coupled with the limited view provided with a laparoscope. In difficult operations, the surgeon may decide to convert to an open procedure to reduce the risk of injury. Injury to the common bile duct requires a large open abdominal operation to correct the problem and restore the normal flow of bile.
Hemorrhage
Occurring in roughly 5 percent of operations, hemorrhage is the most common complication that occurs during laparoscopic gallbladder surgery, according to the "Mymensingh Medical Journal" article. The increased occurrence of this complication in comparison to other laparoscopic procedures is due to the number of large blood vessels that are near the gallbladder. As with common bile duct injury, this complication is associated with abnormal anatomy, infection and inflammation, all of which make laparoscopic dissection more difficult. The complication can usually be controlled through the laparoscope, but in cases of severe bleeding, conversion to an open procedure is necessary.
Bile Leak
Bile that is contained in the biliary system can sometimes leak into the abdominal cavity after gallbladder removal. The leak originates from the small ducts that are present in the gallbladder bed, the stumps of ducts that were severed as part of the procedure, or from the liver and intestine if these structures were injured. Patients experience continued abdominal pain, nausea and vomiting, but in most cases, the leak is self-limiting and requires no treatment beyond antibiotics to prevent infection. Large, persistent leaks are watched and evaluated with additional tests, if symptoms persist. Surgical correction is required for persistent leaks or if the patient shows signs that bile is not appropriately reaching the intestine.
References
- "Mymensingh Medical Journal;" Experience in Laparoscopic Cholecystectomy; M.W. Khan and M.M. Aziz; January 2010
- Surgical Treatment: Complications of Laparoscopic Surgery
- "Complications in Surgery and Trauma"; Stephen M. Cohn; 2007
