- Gallbladder hydrops, massive wall thickening
Begin cholecystectomy with puncture of the gallbladder - Liver capsule tear (also in the area of the Lig. teres hepatis) due to adhesion
Hemostasis with fibrin glue or sealing with fibrin-coated collagen fleece, possibly laparotomy - Accidental gallbladder opening
Suction of bile and irrigation of the surgical area, administration of antibiotics, close perforation site (clip, ligature, or grasping forceps), watch for loss of stones. - Lost stones or clips
Locate and retrieve, possibly using retrieval bag - Injury or partial ligation of the common bile duct (CBD)
Remove all clips, re-preparation with visualization of the confluence and the common bile duct. Place the first clip as close as possible to the gallbladder neck. Drainage. In case of CBD injury, suture with PDS 5-0, possibly conversion, in any case intraoperative or postoperative ERCP with stent placement. - Transection of the common hepatic duct
Laparotomy. Locate the injured common hepatic duct and attempt re-anastomosis, otherwise create a biliodigestive anastomosis. - Uncertain clip closure
Secure closure using Roeder loop; pre-made loop is guided over the grasping forceps, grasp cystic duct stump, place loop near the base. Transect the loop about 5-7mm above the knot. - Bleeding in the bifurcation area of the common hepatic duct
Careful bipolar HF coagulation. Compression, hemostasis with fibrin-coated collagen fleece. For larger vessels: clip, possibly oversewing, in case of laparoscopically uncontrollable bleeding: laparotomy - Bleeding from the cystic artery
Suction of blood, position suction device at perforation site, initially place clip blindly if bleeding site cannot be identified. Then suction and rinse remaining blood, place new clip precisely and remove old one. Prerequisite is the clear identification of the cystic artery. When the bleeding site is visualized, circular dissection of the vessel and targeted placement of clips distally and proximally. - Bleeding from the liver bed
Bipolar HF coagulation, compression, transfixion ligature, insertion of a hemostatic agent (e.g., fibrin-coated collagen fleece), possibly in combination with fibrin glue. - Diaphragm perforation
Repair by suture, possibly laparotomy, placement of a Bülow drain
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Intraoperative Complications
Postoperative complications
Biliary Secretion In the case of bile fluid secretion from the subhepatic drainage or an incision s
Biliary Secretion In the case of bile fluid secretion from the subhepatic drainage or an incision s
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