Laparoscopic cholecystectomy: survey of complications

Laparoscopic cholecystectomy: survey of complications – Tips from Other Journals

The rapid adoption of laparoscopic cholecystectomy as a standard surgical treatment for patients with symptomatic cholelithiasis has been based on advantages such as reduced postoperative morbidity, improved cosmetic results and more rapid resumption of routine activities. In spite of these advantages, clinical trials and anecdotal reports have raised concern about complications, particularly bile duct, bowel or vascular injury. Rates of bile duct injury of up to 2 percent have been reported for laparoscopic cholecystectomy, compared with rates of up to 0.4 percent for open procedures. Estimating the morbidity and mortality of a new surgical procedure is complicated by the operator’s degree of experience. Initial reports of complication rates in laparoscopic cholecystectomy may be low since early series were conducted by.experienced laparoscopic surgeons. Deziel and colleagues studied the complication rates of laparoscopic cholecystectomy to deter- mine the relative safety of the procedure.

Surgical departments in all 4,292 U.S. hospitals with over 50 beds were surveyed. Of the 1,750 hospitals that responded, 1,140 (65.1 percent) reported performing laparoscopic cholecystectomy. An additional 390 hospitals anticipated introducing the procedure within the next six months. Overall, a total of 77,604 laparoscopic cholecystectomies were performed by 5,358 surgeons. The number of procedures performed by the hospitals ranged from one to 2,000, with a mean of 68.

Significant complications were reported in 1,586 patients (2 percent), of whom 951 required laparotomy. Bile duct injury was the most frequent complication, with 459 cases, followed by 193 vascular injuries and 109 incidents of bowel injury. The rate of bile duct injury was significantly higher in hospitals performing fewer than 100 procedures (0.65 percent), compared with those with more experience (0.42 percent). The most frequently injured duct was the common bile duct (271 cases), followed by the cystic duct (94 cases), aberrant ducts (48 cases) and common hepatic duct (38 cases). Five deaths were attributed to bile duct injury.

Vascular injuries occurred during gall-bladder dissection and during trocar placement. The cystic artery was the most frequently injured vessel, with 73 cases. The 109 cases of bowel injury had a variety of causes, including puncture by instruments, electrocautery burns and mechanical injury during retraction. Other surgical complications included bile leakage, subcutaneous emphysema and stone loss. Of the 33 deaths that occurred in 77,604 patients, 18 were attributed to operative injury.

The low mortality rate, as well as the pattern and low incidence of nonlethal complications, lead the authors to conclude that laparoscopic cholecystectomy is essentially a safe procedure, which may become even safer with increased experience.

COPYRIGHT 1993 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group