Complications - Cholecystectomy, laparoscopic - general and visceral surgery
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Intraoperative complications
- Hydropic gallbladder, massively thickened wall
Start the cholecystectomy by puncturing the gallbladder.
- Adhesion induced tear of the liver capsule (incl. the region of the round hepatic ligament)
Adapt the liver with sutures, stop bleeding with fibrin sealant or seal off with fibrin-coated collagen fleece, possibly convert to open surgery
- Accidental gallbladder perforation
Suction the fluid escaping from the gallbladder and rinse the surgical field; administer antibiotics; close off the perforation (clip, ligature or grasping forceps); look out for spilled calculi
- Lost calculi and clips
Locate and retrieve, possibly with specimen retrieval bag
- Injury or partial ligation of CBD
Remove all clips, redo the dissection with unequivocal exposure of the union of the cystic duct with the CBD. Place first clip as close to the gallbladder as possible. Insert drain. In case of injury to the CHD: Suture, possibly convert to open surgery. In case of postoperative problems perform ERC with possible papillotomy and stenting.
- Transection of the common hepatic duct
Laparotomy Identify the injured common hepatic duct and attempt anastomosis; if unsuccessful perform bilioenteric anastomosis.
- Unreliable clip closure
Reliable closure with Roeder slipknot loop; slip the ready-made loop over the forceps, grasp the stump of the cystic duct and place the loop as close to the base of the cystic duct as possible. Cut off the loop about 5-7 mm above the slipknot.
- Bleeding near the bifurcation of the common hepatic duct
Careful bipolar RF coagulation. Compression, hemostasis with fibrin-coated collagen fleece.
For larger bleeders: Clipping, possible suture ligation
In hemorrhage, not amenable to laparoscopic hemostasis: Laparotomy
- Bleeding from the cystic artery
Position the suction tip close to the source of the hemorrhage; if the site of the bleeder cannot be identified for certain, blindly place an initial clip. Now suction the blood, rinse the field and suction it dry; precisely apply a new clip and remove the first clip. This mandates that the cystic artery has been identified for certain. When exposing the site of a bleeder dissect it free around its circumference and carefully clip it distally and proximally.
- Bleeding from the liver bed
Bipolar RF coagulation; compression; suture ligation; application of a hemostatic (e.g., fibrin-coated collagen fleece); possibly combined with fibrin glue
- Perforation of the diaphragm
Close with suture, possibly convert to open procedure; insert chest tube
Postoperative complications
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