What are the potential complications of laparoscopic cholecystectomy?

From the Guidelines

Laparoscopic cholecystectomy can lead to several potential complications, including bile duct injuries, blood loss, operative time, general morbidity, and mortality rates.

Potential Complications

• Bile duct injuries, which can occur in 0.4-1.5% of cases, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life 1
• Blood loss and operative time, which can be increased in cases of local inflammation, especially in gangrenous and emphysematous acute calculus cholecystitis (ACC) 1
• General morbidity, including wound infection, pneumonia, and other complications, which can be decreased with the laparoscopic approach 1
• Mortality rates, which can be decreased with the laparoscopic approach, especially in cases of early laparoscopic cholecystectomy (ELC) 1

Risk Factors

• TG13 grade 3 acute cholecystitis, which is associated with an increased risk of all-cause mortality compared to grade 1 1
• Male gender, which is associated with an increased risk of complications and conversion to open cholecystectomy 1
• Previous upper abdominal surgery, which is a risk factor for conversion to open cholecystectomy due to intra-abdominal adhesions 1
• Increased age, which can have a cumulative increase in the conversion to open cholecystectomy due to comorbidities and increased cumulative risk of upper abdominal surgery 1

Management

• Laparoscopic cholecystectomy is generally considered the standard technique for the removal of gallstones, with a lower complication rate and shorter hospital stay compared to open surgery 1
• Early laparoscopic cholecystectomy (ELC) is recommended for patients with acute calculus cholecystitis, with a significant reduction in wound infection, hospitalization, duration of surgery, and quality of life 1
• Delayed laparoscopic cholecystectomy (DLC) may be considered in cases where ELC is not possible, with no differences in mortality, bile duct injury, bile leakage, overall complications, and conversion to open surgery compared to ELC 1

From the Research

Potential Complications of Laparoscopic Cholecystectomy

The potential complications of laparoscopic cholecystectomy can be categorized into major and minor complications.

• Major complications include:
  • Bile duct injuries, such as common bile duct injury or transection 2, 3, 4, 5
  • Bile leakage, which can occur from accessory ducts or the cystic duct stump 2, 3, 4
  • Retained stones or gallstones in the abdominal cavity 2, 3, 4
  • Bleeding or hemorrhage, which can be life-threatening 4, 5
  • Bowel injuries, such as perforation or transection 3, 4, 5
• Minor complications include:
  • Wound infections or abscesses 2, 3, 4
  • Urinary tract infections 2
  • Shoulder or back pain 3
  • Nausea and diarrhea 3
  • Subcutaneous emphysema or pneumoperitoneum 3, 5
  • Prolonged ileus or hospital stay 2, 3

Risk Factors and Prevention

The risk of complications can be minimized by proper patient selection, meticulous technique, and an accepting attitude toward conversion to open cholecystectomy 2, 3, 6.

• Early identification and management of complications are crucial to prevent potentially devastating outcomes 2, 3, 4, 6.
• The learning curve phenomenon can also contribute to the occurrence of complications, especially during the early period of experience with laparoscopic cholecystectomy 3.
• Careful dissection of the hepatocystic triangle and appreciation of the limitations and pitfalls of laparoscopic surgery can help avoid iatrogenic injuries 6.