- 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
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Postoperative complications
- Biliary Secretion
In the case of bile fluid secretion from the subhepatic drainage or an incision site: ERC,
if a bile duct leak is detected:
Papillotomy, possibly endoscopic, transpapillary stent placement for three weeks, possibly longer.
If ERC shows free flow and tightness of the bile duct system, and sufficient drainage exists:
Initially, wait.
If the fistula persists over time: Diagnostic laparoscopy, possibly switching to laparotomy. - Peritonitis
Explorative laparoscopy with swab collection, lavage, and focus sanitation (e.g., closure of a bile duct leak or bowel perforation), irrigation, and target drainage placement, antibiotic therapy.
Possibly laparotomy, in the case of extensive findings with septic multiorgan failure, staged lavage or relaparotomy on demand, intensive medical therapy. - Subhepatic (subphrenic) Empyema/Abscess
Initially, CT-guided puncture and drainage placement, if not possible or unsuccessful:
Laparoscopy/laparotomy, swab collection, lavage, and possibly detection and sanitation of an infection source (lost stone, bowel injury), target drainage. - Bleeding
Relaparoscopy and targeted hemostasis. If the bleeding source is not clearly localizable: Laparotomy - Increase in Laboratory Parameters
In case of an increase in transaminases and bilirubin: ERC and color duplex of the liver vessels to clarify the cause, possibly angio-CT of the upper abdomen. - Jaundice
Laboratory chemical, then endoscopic clarification of the cause. In case of organic or calculus-induced stenosis, papillotomy, possibly duct sanitation and stent placement. - Wound Healing Disorder
Opening of the wound, irrigation, open wound treatment.
- Biliary Secretion