Gall bladder Surgery Study Finds Bile Duct and Bowel Injuries
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A study was published in the European Journal of Surgery 160:145 (1993), entitled “Complications During the Introduction of Laparoscopic Cholecystectomy in Norway”. Five hundred and twenty patients underwent laparoscopic gall bladder surgery. Three had bile duct injuries, two had bowel (intestine) perforation and 10 had bile leaks. The two patients who had bowel injuries both had intra-abdominal adhesions after previous operations. In one patients the insufflation needle and subsequently a ten millimeter trochar were inserted into part of the small bowel that was adherent to the anterior abdominal wall; in the other the transverse colon was perforated during dissection of adhesions. The bowel lesions were closed at laparotomy and gallbladder removed. There were no post operative complications in these patients.
Of the three patients with the injuries to the cystic ducts, the injuries were recognized and the operation was converted to a laparotomy. The injuries were repaired. Laser (Nd-YAG) was used for dissection of the gallbladder in 35 patients in one center and in 2 patients in another. The rate of complications in this group of patients was 21.6 percent compared with 12.7 percent (62/490) in patients in whom electrocautery was used. Some complications are associated with a learning curve. Electrocautery is regarded as a better coagulant than laser. Most injuries to the bile ducts are not associated with anomalies of the ducts.
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The most common causes seem to be inexperience, inflammation in Calot’s triangle and inadequate visualization because of bleeding or intra-abdominal adhesions. Bowel injury is a feared complication occurring in 0 to .8 percent in series of cholecystectomy. Bowel injuries are usually associated with adhesions after previous abdominal operations. When adhesions are expected alternative sites for insertion of the insufflation needle and trochars are open access through the umbilicus must be considered. Adhesions should be dissected at their junction with peritoneum and under meticulous hemostatic control to secure optimal view and exposure.
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