Analysis Of Causes,Prevention And Treatment Of Complications In Laparoscopic Cholecystectomy

Objective: To analyse the causes of complications of laparoscopic cholecystectomy(LC)and to explore the treatment and prevention of complications.To analyse the reasons of conversion to open cholecystectomy(OC)during LC,and to explore the opportunity of conversion to open surgery.Methods: Clinical data of 1574 cases of LC patients in our hospital from January 2013 to December 2015 were retrospectively analyzed.The incidence of various complications of LC was recorded and their causes was analyzed,and the prevention and treatment of complications were discussed.The incidence of conversion to open surgery was recorded and the causes were analyzed,and the timing of conversion to open surgery was discussed.Results: 1574 patients were completed surgery,conversion to open surgery in 37 cases,the conversion rate was 2.35%(37/1574),there were no deaths during the operation.The operation time was 18~157min,average 49.2±11.7min,the amount of bleeding was 0~450ml,average 8.2±4.3ml.LC intraoperative and postoperative complications occurred in 47 patients,the incidence of LC was 2.99%(47/1574).The major complications of LC included bile leakage in 10 cases(0.64%),due to eschar shedding,the accidental injury of electrocantery,titanium clip off and shedding of titanium clip,etc.Underwent the electric coagulation closure,bile duct clipping or suture,abdominal drainage and bile duct repair,good recovery.Abdominal bleeding in 9 cases(0.57%),due to accidental injury of gallbladder artery,liver laceration,deep separation of gallbladder bed,etc.Underwent electric coagulation hemostasis and vascular occlusion or suture,good recovery.Postoperative residual stones of biliary tract in 6 cases(0.38%),due to preoperative misdiagnosis and intraoperative small gallbladder stones falling into the common bile duct.Underwent antispasmodic,anti-inflammatory conservative therapy and endoscopic stone extraction(EST,EPBD),good recovery.Bile duct injury in 4 cases(0.25%),due to electric coagulation hook thermal injury,bile duct mistakenly believe that cystic duct ligated and cut,pulling force makes the angle of the common bile duct,etc.Underwent repair of bile duct,bile duct end-to-end anastomosis and bile duct jejunum Roux-en-Y anastomosis,good recovery.Gastrointestinal injury in 5 cases(0.32%),due to grasping bowel overexert,electric coagulation hook thermal injury and biliary enteric fistula,etc.Underwent one-stage repair,a fistula and two-stage repair in laparoscopic or laparotomy,good recovery.Other less common and less severe complications included bleeding from the incision in 4 cases(0.25%),peritoneal infection in 4 cases(0.25%),subcutaneous emphysema in 2 cases(0.13%).A total of 37 cases of open surgery,which due to complications of laparotomy in 6 cases.Abdominal bleeding in 3 cases(8.11%),underwent electrocoagulation,clamp and suture in laparotomy and hemostasis.Bile duct injury in 2 cases(5.41%),underwent repair of bile duct and bile duct jejunum Roux-en-Y anastomosis in laparotomy,good recovery.Gastrointestinal injury in 1 cases(2.70%),underwent one-stage repair of the duodenum,good recovery.The other reason to laparotomy in 31 cases.Severe adhesion in 11 cases of gallbladder(29.73%),underwent lysis of peritoneal adhesion in laparotomy,good recovery.Gallbladder triangle processing difficulties in 8 cases(21.62%),underwent retrograde cholecystectomy,good recovery.Mirizzi syndrome in 5 cases(13.51%),underwent laparotomy for bile duct repair and bile duct jejunum Roux-en-Y anastomosis,good recovery.Gallbladder atrophy in 4 cases(10.81%),underwent partial cholecystectomy,good recovery.Unsuspected gallbladder carcinoma in In 3 cases(8.11%),underwent open cholecystectomy + liver duodenal lymph node dissection,1 case died in the postoperative half year,2 cases were still under follow-up.Conclusion: LC has a certain level of complication rate and major complications including bile leakage,bile duct injury,abdominal bleeding,postoperative residual stones of biliary tract and gastrointestinal tract injury etc.,often due to anatomical variation,the operation is non-standard and other reasons.The surgical indications should be strictly controlled,fully improve the relevant examination and evaluate the operation difficulty before the operation.Familiar with the local anatomy and variation,standardized operation,be on the alert and timely conversion to laparotomy during the operation.Closely observe the patient's condition changes after the operation.If an exception occurs,they should be made the necessary inspection as early as possible and treated timely.The complications of LC which are complex must adopt individualized treatment.We should make treatment strategies according to the complications were found in time,nature and extent,the general condition of patients and liver function.