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Complications - Cholecystectomy, open

general and visceral surgery
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Intraoperative Complications

    • Liver capsule tear (also in the area of the Lig. teres hepatis) due to adhesion
      Adaptation using liver suture, hemostasis with fibrin glue or sealing with fibrin-coated collagen fleece
    • Injury to the bile ducts peripherally or centrally
      Drainage. In case of CHD injury suture, if necessary attempt re-anastomosis. Here the suture must be splinted with a T-drainage for a certain time. In extreme cases, consider a biliodigestive anastomosis. This procedure requires detailed specialist knowledge! Therefore, better to transfer the patient to a corresponding center!
    • Injury to the right branch of the proper hepatic artery
      Vascular surgical care
    • Injury to adjacent hollow organs
      Simple oversewing

  2. Postoperative Complications

    • Stone passage during the surgery with obstruction of the DHC
      see below
    • Jaundice
      Laboratory chemical, then endoscopic clarification of the cause. Papillotomy, if necessary duct cleaning and stent insertion.
    • Biliary secretion
      In case of bile fluid secretion from the subhepatic drainage or an incision site: ERC,
      in case of evidence of a bile duct leakage: Papillotomy, endoscopic, transpapillary stent insertion for three weeks, possibly even longer.
      If ERC shows free drainage and tightness of the bile duct system, and sufficient drainage exists: Initially wait and see, in case of persistence of the fistula in the course diagnostic laparotomy.
    • Peritonitis
      Laparotomy with exploration of the entire abdominal cavity, sanitation of the focus, pathogen detection from exudate and lavage, if necessary staged lavage or relaparotomy on demand, antibiotic therapy, if necessary intensive care therapy.
    • Subhepatic (subphrenic) empyema/abscess
      Initially CT-guided puncture and insertion of a drainage, if not possible or without success:
      Laparotomy, swab collection, lavage and if necessary detection and sanitation of an infection source (lost stone, intestinal injury), targeted drainage.
    • Bleeding
      If necessary surgical hemostasis
    • Increase in laboratory parameters
      E.g. in case of impairment of liver perfusion due to accidental ligation of the right branch of the hepatic artery; therefore in case of increase in transaminases and bilirubin: ERC and color duplex of the liver vessels for clarification of the cause, if necessary angio-CT of the upper abdomen.
    • Wound healing disorder
      Opening of the wound, rinsing, open wound treatment