Analysis of complications and clinical and pathologic factors in relation to the laparoscopic cholecystectomy

Česká verzia

Authors: V. Liška ^1,2; R. Pálek ¹; V. Třeška ¹; D. Glanc ¹; M. Svobodová ¹
Authors place of work: Chirurgická klinika, Lékařská fakulta a Fakultní nemocnice v Plzni, Karlova univerzita v Praze přednosta: Prof. MUDr. V. Třeška, DrSc. ¹; Biotechnologické centrum, Lékařská fakulta, Karlova univerzita v Praze vedoucí pracoviště doc. MUDr. M. Štengl, Ph. D. ²
Published in the journal: Rozhl. Chir., 2014, roč. 93, č. 3, s. 123-131.
Category: Original articles

Summary

Introduction:
Laparoscopic cholecystectomy (LCHCE) is connected with a different spectrum of postoperative complications than classic cholecystectomy. The aim of this study was to analyse the complications and define their relation to some chosen clinical and pathological factors and their incidence.

Material and methods:
We included 1014 patients that were operated (laparoscopic or converted cholecystectomy) at the Department of Surgery, University Hospital in Pilsen between January 1st 2008 and December 31th 2011. All included patients were at least one year after cholecystectomy in the time of the realization of this study therefore we could analyse late complications. The group of patients included 351 men (34.6%) and 663 women (65.4%). The median age was 57 years (range: 8–87 years). We evaluated the following clinical and pathological factors: a histopathological diagnosis, early surgical and internal complications (with manifestation within 30 days after cholecystectomy) classified by the Clavien-Dindo score, incisional hernia as a late complication, conversion, perforation of the gallbladder wall, the duration of hospital stay, the age of patients and the use of drain. The results of the study were calculated with use of statistical tests: the test of population probability, the two-sample t-test, the ODDS ratio) and then were compared with published literature data.

Results:
Surgical and internal complications occurred in 138 patients (13.6%) within 30 postoperative days. The most common complication was connected with the wound – 92 patients (9.1%), then a hematoma in the gallbladder bed – 16 patients (1.6%) and a biliary leak - 16 patients (1,6%). The bile duct injury which needed a reoperation affected 3 patients (0.3%). The laparoscopic operation had to be converted in 77 cases (7.6%). Incisional hernia after the placing of trocars or in the scar after the laparotomy (in the case of conversion) occurred in 32 patients (3.16%) during one year after the cholecystectomy. The influence of the age of patients on the incidence and the spectrum of postoperative complications were proved as statistically significant. Postoperative complications were more common in the case of male gender. We found a correlation between the diagnosis and postoperative complications. Men with solitary cholecystolithiasis had more common incidence of hematoma in the gallbladder bed. A biliary leak occurred three times more often after the procedures with a gallbladder wall perforation. Three of four bile duct injuries occurred during the non-converted laparoscopic cholecystectomies.

Conclusion:
Our study proved the influence of the age of patients, the histopathological diagnosis, conversion and the perforation of gallbladder wall on the incidence of postoperative complications after laparoscopic cholecystectomy. The incidence of bile duct injury, which is the most serious complication, in our group of patients is comparable with published literature.

Key words:
laparoscopic cholecystectomy – complications – biliary leak – bile duct injury – Dindo-Clavien score

Zdroje

1. Wu YV, Linehan DC. Bile duct injurie in the era of laparoscopic cholecystectomies. Surg Clin N Am 2010;90:787–802.

2. Targarona E.M, Marco C, Balagué C, et al. How, when, and why bile duct injury occurs. A comparison between open and laparoscopic cholecystectomy. Surg Endosc 1998;12:322–326.

3. Schafer M, Lauper M, Krähenbühl L. Trocar and Veress needle injuries during laparoscopy. Surg Endosc 2001;15:275–280.

4. OrlandoR, Palatini P, Lirussi F. Needle and trocar injuries in diagnostic laparoscopy under local anesthesia: what is the true incidence of these complications? Laparoendosc Adv Surg Tech A 2003;13:181–184.

5. Papasavas PK, Caushaj PF, Gagné DJ. Spilled gallstones after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2002;12:383–386.

6. Wetscher G, Schwab G, Fend F, et al. Subcutaneous abscess due to gallstones lost during laparoscopic cholecystectomy. Endoscopy 1994;26:324–325.

7. Schafer M, Suter C, Klaiber C, et al. Spilled galstones after laparoscopic cholecystectomy. A relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies. Surg Endosc 1998;12:305–309.

8. Horton M, Florence MG. Unusual abscess patterns following dropped gallstones during laparoscopic cholecystectomy. Am J Surg 1998;175:305–379.

9. Shamiyeh A, Wayand W, et al. Laparoscopic cholecystectomy: Early and late complications and their treatment. Langenbecks Arch Surg 2004;389:164–171.

10. Schrenk P, Woisetschläger R, Rieger R, Wayand W. Mechanism, management, and prevention of laparoscopic bowel injuries. Gastrointest Endosc 1996;43:572–574.

11. MacFadyen BV Jr, Vecchio R, Ricardo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy. The United States expirience. Surg Endosc 1998;12:315–321.

12. Jatzko GR, Lisborg PH, Pertl AM, Stettner HM. Multivariate comparaison of complications after laparoscopic cholecystectomy. Ann Surg 1995;221:381–386.

13. Strasberg S.M, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995;180:101–125.

14. Massoumi H, Kiyici N, Hertan H. Bile leak after laparoscopic cholecystectomy. Clin Gastroenterol 2007;41:301–305.

15. Fletcher DR, Hobbs MS, Tan P, Valinsky LJ, et al. Complications of cholecystectomy: risk of the laparoscopic approach and protective effects of operative cholangiography: a population based study. Ann Surg 1999;229:449–457.

16. Piacentini F, Perri S, Pietrangeli F, Nardi M Jr, et al. Intraoperativ cholangiography during laparoscopic cholecystectomy: selective or routine? G chir 2003;24:123–128.

17. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13.

18. Cuschieri A, Dubois F, Mouiel J, et al. The European expirience with laparoscopic cholecystectomy. Am J Surg 1991;161: 1385–387.

19. de Goede B, Klitsie PJ, Hagen SM et al. Meta-analysis of laparoscopic versus open cholecystectomy for patients with liver cirrhosis and symptomatic cholecystolithiasis. Br J Surg 2013; 100:209–16.

20. Kandil T, El Nakeeb A, El Hefnawy E. Comparative study between clipless laparoscopic cholecystectomy by harmonic scalpel versus conventional method: a prospective randomized study. J Gastrointest Surg 2010;14:323–328.

21. Grbas H, Kunisek L, Zelic M, et al. Outcome evaluation of 10317 laparoscopic cholecystectomies: a 17-year experience at single center. Hepatogastroenterology, 2013;12. doi: 10.5754/hge 121136.

22. Lengyel BI, Azagury D, Varban O, et al. Laparoscopic cholecystectomy after a quarter century: why do we still convert? Surg Endosc 2012;26:508–513.

23. Verner T. Komplikace laparoskopické cholecystektomie. Rozhl Chir 2013;92:107–111.

24. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992;111:518–26.

25. Duca S, Bala O, Al-Hajjar N, et al. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB (Oxford) 2003;5: 152–158.

26. Domeyer PJ, Sergentanis TN, Zagouri F, et al. Chronic cholecystitis in elderly patients. Correlation of the severity of inflammation with the number and size of the stones. In Vivo 2008;22: 269–72.

27. Agabiti N, Stafoggia M, Davoli M et al. Thirty-day complications after laparoscopic or open cholecystectomy: a population-based cohort study in Italy. BMJ Open 2013;13. doi:pii: e001943. 10.1136/bmjopen-2012-001943.

28. Marks JM, Phillips MS, Tacchino R, et al. Single-incision laparoscopic cholecystectomy is associated with improved cosmetic scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy. J Am Coll Surg 2013;216:1037–1047.

29. Comajuncosas J, Hermoso J, Gris P, et al. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 2013 Oct 7. doi:pii: S0002-9610(13)00487-X. 10.1016/j.amjsurg.2013.05. 010.

30. Zannoni M, Viani L, Caramatti C, et al. Can we pursue minimal invasive surgery in the setting of converted laparoscopic cholecystectomy? Consideration about the „MIVAC“ approach. Minerva Chir 2012;67:469–473.

31. Yajima H, Kanai H, Son K, et al. Reasons and risk factors for intraoperative conversion from laparoscopic to open cholecystectomy. Surg Today 2012 Dec 24. [Epub ahead of print]

32. van der Steeg HJ, Alexander S, Houterman S, et al. Risk factors for conversion during laparoscopic cholecystectomy – experiences from a general teaching hospital. Scand J Surg 2011;100:169–173.

33. Le VH, Smith DE, Johnson BL. Conversion of laparoscopic to open cholecystectomy in the current era of laparoscopic surgery. Am Surg 2012;78:1392–1395.

34. Ahmed S, Ali AA, Hasan M, Awal A. Problems leading to conversion in laparoscopic cholecystectomy. Mymensingh Med J 2013;22:53–58.

35. Miroshnik M, Saafan A, Koh S et, al. Biliary tract injury in laparoscopic cholecystectomy: results of a single unit. ANZ J Surg 2002;72:867–870.

36. Hüscher CG, Lirici MM, Di Paola M, et al. Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature. Surg Endosc 2003;17:442–451.