Abstract

Background: Laparoscopic surgeries have experienced a boom since the 1990’s. The benefits of laparoscopic approach were so readily apparent that laparoscopic procedures soon became the standard of care without any randomized controlled trials comparing it to the previous gold standard procedures (e.g. Cholecystectomy). Laparoscopy by definition is minimally invasive surgical approach which is being used in many minor and major surgeries. The significant advantages seen in laparoscopic surgeries are minimal blood loss, reduced hospital stay, less post-operative pain, disability and quicker recovery as compared to open surgeries. As more and more surgeries are being done laparoscopically the incidence and magnitude of complications is also expected to increase. It is of crucial importance that the complications associated with laparoscopic surgeries be identified in time to prevent serious patient sequelae and morbidity. A complication is defined as a new problem or illness that makes the treatment of a previous or pre-existing condition more difficult. Complications of laparoscopic procedures can be broadly divided as general complications of laparoscopy and complications specific to the procedure itself. With this background knowledge from the literature we conducted this study to evaluate various complications which occur during and after laparoscopic procedures and to find a correlation between complications and pre-existing risk factors.

Aims and Objectives: (1) To study, the correlation between pre-operative risk factors and various complications occurring during and after laparoscopic procedures. (2) To study the incidence and enumerate various complications occurring during intra-operative and post-operative period in laparoscopic procedures (3) To classify various complications occurring based on the different steps and different procedures. (4) To study the correlation between various pre-operative risk factors and the different complications occurring in laparoscopic procedures.

Materials and Methods: This study was conducted after getting approval from institutional ethical committee. This was a prospective cohort study comprising of 600 patients undergoing laparoscopic procedures at a tertiary care centre over a period of 2 years. The patients undergoing basic laparoscopic procedures as well as advanced laparoscopic techniques were included in this study depending upon defined inclusion and exclusion criteria. We focused on the type of complications in relation to the procedure and the time of occurrence. The inpatient and outpatient visits of every patient were followed up, to assess intra-operative and post- operative complications. Procedures were classified as basic laparoscopic procedures (cholecystectomy, appendectomy, diagnostic laparoscopy, IPOM, and hernia surgeries) and advanced laparoscopic procedures (abdomino-perineal resection, gastrectomy, anterior resection, nephrectomy, splenectomy, esophagectomy, metabolic surgery, CBD explorations and pyelolithotomy).complications were evaluated and listed according to specific procedures and grouped with respect to the surgical step during laparoscopy to distinguish access trauma (trocar related injuries), dissection trauma (injury during dissection) associated trauma (hypercarbia, hypotension, pulmonary embolism) and wound related complications.

Results: Out of 600 studied cases 310 (51.67%) were males and 290 (48.33%) were females with a m:f ratio of 1:0.93 . Most common age group of the patients was between 41-50 (23%) years followed by 31-40 (19.17%) years and 21-30 (18.83%) years. Complications were seen in 41 (6.83%) patients. Analysis of preoperative risk factors revealed that anemia was present in 184 (30.7%) patients while hypoprotinemia was present in 101 (16.8%) patients. Diabetes was found to be present in 16 (2.7%) patients. The cases were divided into ASA scores. 567 (94.5%) patients belonged to ASA I while 27 (4.5%) and 6 (1%) patients belonged to ASA II and III respectively. The duration of surgery was found to be less than 2 hours in 201 (33.5%) patients while the duration was 2-6 hours and more than 6 hours in 384 (64%) and 15 (2.5%) patients respectively. The complications found in basic laparoscopic procedures were most common in diagnostic laparoscopies (8.69%) followed by hernia repair (8.51%) and laparoscopic cholecystectomy (5.52%). The overall complication rate seen in basic laparoscopic procedures was found to be 5.59%. In advanced laparoscopic procedures the highest complication rate was seen with miscellaneous procedures (23.5%) followed by laparoscopic combined procedures (20%) and colorectal surgeries (9.52%). The most common complications seen were wound infections/healing (2.16%) followed by visceral injuries (1.66%) and miscellaneous complications (1.66%) less common complications included vascular and access related injuries (0.33% each). Most complications (4.5%) occurred during early post-operative period (up to 6 weeks) followed by during late post operative period (1.33%) and intra-operative period (1%). Mortality was low (0.33%) that too was seen in patients suffering from malignant diseases.

Conclusion: Laparoscopic surgeries have a definite advantage over conventional surgeries. The main advantages include low rate of post-operative infections, less blood loss, short hospital stay and reduced morbidity. Our study concludes that most of the benign and malignant intra-abdominal pathologies can be safely dealt by laparoscopy with acceptable complication rates. Rational selection of patients, experienced surgeons, proper pre-operative work up and a low threshold for conversion will further reduce the incidence of complications.

Keyword: laparoscopic surgeries, complications, pre-operative risk factors, outcome.