Abstract
Introduction: The first Laparoscopic cholecystectomy was performed by Erich Muhe in 1985 (Germany), followed by Mouret (1987 France)[1]. Laparoscopic cholecystectomy got accepted as a safe and better operation for G.B. stones in 1992 [2]. Laparoscopic cholecystectomy became popular in demand with time, because of its better cosmesis, minimal incisions, low morbidity and pain, short hospital stay, and recovery [3]. But it also had it's accompanying complications[5,14]. Thus many cases of Laparoscopic cholecystectomy were converted into a Laparotomy, when any of these complications developed.
Methods: Study of the incidence of complications, predisposing factors and the rate of conversion of Laparoscopic cholecystectomy into Open Laparotomy was done. 410 patients, who were put up for Laparoscopic cholecystectomy in Nalanda Medical College, Patna from March 14 - March 17 were observed.
Results: Randomized study of 410 patients of G.B. stones, put up for Laparoscopic cholecystectomy was done. Their median age was 40 yrs (range 16-64) and sex ratio was 403 F: 7 M. The common operative complications, their predisposing factors and the rate of conversion were observed.
Conclusion: 410 patients of G.B. stones, after proper clinical evaluation, Lab investigations and cardiological check-up were put up for Laparoscopic. cholecystectomy. The most common and dreadful complication was Bile Duct injury (common bile duct/common hepatic duct). It's incidence was 2.7% (11 patients) [11,12,13]. The next common complication was internal bleeding (cystric artery/liver bed / hepatic artery / aberrant vessels), seen in 1.7% (7 patients) [14,15]. Injury to intestines, liver, major vessels, due to electrocautery accidents during adhesiolysis or introduction of Veress / trocar for ports, was 0.9% (4 patients) [16]. Leakage of Bile/Spilled stones was seen in 0.7% (3 patients)[17]. Cardiac arrhythmia or hypotension due to pneumoperitoneum was seen in 0.7% (3 patients).
Keywords: Laparoscopic cholecystectomy (Lap. Chole./LC), C.B.D, Cystic artery, Hepatic artery, Murphy's Sign, Gall stones, common Hepatic D.
References
- Muhe E; Laparoskopische cholecyste-ktomie -- Endoscopic Heute; 1990 : 4 : 262 - 266
- National Institutes of Health (NIH) :- Gall Stones and Laparoscopic cholecystectomy; NIH Consensus Statement, Sept. 14-16, 1992
- Shea JA, Berlin JA, Bachwich DR et.al. Indications for and outcome of cholecystectomy :- a comparison of the pre and post Laparoscopic era Ann. Surg. 1998, March, 227 (3) PP 343-350
- Mcsherry CK :- cholecystectomy - the gold standard Arm, Surg. 1989, Sept. 158 (3), 174-178
- Ponsky JL. Complications of laparoscopic cholecystectomy. Am. J. Surg. 161 : 393, 1991.
- Novitsky Y.W., Kercherkw et.al :- Advantage of Mini Lap. Vs conservative Lap. cholecystectomy, Arch.Surg. 2005 Dec., 140 (12). 1178-1183
- Yamazaki M, Yasuda H, Koda K, : - Single incision Lap. cholecystectomy - a systemic review of methodology and outcomes, Surg. Today May, 22 2014
- Hunter JG : - Acute cholecystitis revisited - get it while it's hot, Ann. Surg. 1998, April, 227 (4), 468-469
- Sultan AM, EL Nakeeb A, et.al :- risk factors for conversion during Lap. Chole - Analysis of ten years experience at Single Tertiary referral center, Dig. Surg, 2013, April :26 : 30(1). 51 - 55
- Bhansali SK. Preoperative complications of gall stones and their relevance to treatment and prognosis-experience with 451 cases. Am J Gastroenterol 80: 648, 1985.
- Martin RF, Rossi RL, Bile duct injuries :- spectrum of mechanisms of injury and their prevention; Surg. Clin. North Am. 4 : 781; 1994
- Steward L, Way LW:- Bile duct injuries during laparoscopic cholecystectomy-factors that influence the result of treatment. Arch Surg. 130: 1123, 1995.
- Schol EPG, Go P.M. et.al. : - Risk factors for bile duct injury in Lap.chole- analysis of 49 cases; Br. J. Surg; 1994 : 81 : 1786- 1788
- Downs SH, Ryoston CMS, Black NA et.al. Systematic review of the effectiveness and safety of laparoscopic cholecystectomy. Ann Roy Coll Surg. Engl. 78 : 241, 1996
- Moore M.J. Bennett OL : - The learing curve for Lap. Chole. The Southern Surgeons Club, Am.J. Surg. 1995: July; 170(1), 55-59
- The Southern Surgeons Club : - A prospective analysis of 1518 Lap. Cholecystectomies, N.Eng. J. Med. 1991 April 18 : 324 (16): 1073 – 1078
- Huang S.M. Wu. C.W. et.al:- Bile Duct injury and bile leakage in Lap.Chole; Br. J. Surg. 1995 : 80 : 1590 - 1592
- Jatzko G. et.al. :- Multivariate comparison of complications after Lap.Chole. and Open Chole; Arm. Surg; 1995 : 221 : 381- 386
- Fabre J.M., Fagot H., et.al. : - Lap. chole. in complicated cholelithiasis Surg. Endosc; 1994 : 8 : 1198 – 1201
- Bedogni G. Mortilla M.G. et.al. : - 1994. The role of endoscopic treatment of early biliary complication of Lap. chole./Lap. Surg. pp. 145-188
- Goldman, Lee (2011) :- Goldman's Cecil Medicine 24thed., Philadelphia Elsevier Saunders, p 940, p 1017.
- Glasgow RE, Mulvihill SJ (2010) :- Treatment of Gall Stones disease in M, Fieldman et.al; ed: Gastro-inestinal and liver diseases, 9th ed vol-I pp 1121-1138 Philadelphia Saunders.
- Joseph M (2012) – Single incision Lap.chole. associated with increased rati of Bile duct Injury, Ann. Surg. 206(I) p-1-6.
- Kapoor V.K. (2009) :- Bile duct Injury repair – When, where who in journal Hepato-Biliary pancreatic surgery, 14(5) pp 476-479.
Corresponding Author
Dr Mohammad Eqbal Ahmad
MBBS MS (Surg.) FAIS, D.A.
Associate Professor, Dept. of Surgery, Nalanda Medical College, Patna