Purpose : Laparoscopic cholecystectomy (LC) has become the standard treatment of benign gallbladder disease. Surgical complications of LC usually developed during early period due to inexperience technique and late period because surgeon had tendency to decide the indications of operation widely. This is a retrospective study of 10 patients who had major surgical complications by elective LC.
Methods : We studied 748 consecutive patients who had been treated by elective LC which were done by one surgeon at the department of general surgery of Maryknoll Hospital from February 1992 to February 2002. Of these patients, there were 10 patients who had major surgical complications such as bile leakage, bile duct injury, bleeding and bowel injury. All patients were managed using a multidisciplinary approach.
Results : Total 10 patients had major surgical complications. We devided this duration into three period according to similar operation numbers. Roux-en-Y hepaticojejunostomy was employed in one patient with bile duct injury. For bile leakage, two patients were treated by laparoscopic irrigation. Choledochostomy with T-tube was done in two patient. In patients with bleeding, laparoscopic irrigation for one, open cholecystectomy with bleeding control for three patients were done. For duodenal perforation by troca was treated with primary suture. There was no mortality case in this study.
Conclusion : Surgical complications of LC usually developed during immature period due to inexperience technique and mature period because surgeon had tendency to decide the indications of operation widely. The best treatment is the prevention by careful surgical technique and if they occur, the best moment to repair them is during surgery. The treatment plan for surgical complications must be individualized for every patient, depending on the injury type, presentations, and condition of the patient.
|