- Liver Capsule Tear (including the area of the ligamentum teres hepatis):
- Manage with fibrin glue or fibrin-coated collagen fleece
- Gallbladder Hydrops or Severe Wall Thickening (Difficult Handling):
- Initiate cholecystectomy by puncturing the gallbladder
- Accidental Gallbladder Perforation:
- Aspirate bile and irrigate the surgical field
- Administer antibiotics
- Close the perforation with a clip, ligature, or grasping forceps
- Check for and recover any lost stones
- Lost Stones or Clips:
- Search for and retrieve lost items, possibly using a retrieval bag
- Injury or Partial Ligation of the Common Bile Duct (DHC):
- Remove all clips
- Redissect to expose the confluence and DHC
- Place the first clip close to the gallbladder neck
- Insert a drain
- If DHC is injured, suture with PDS 5-0. Consider conversion or intra-/postoperative ERCP with stent placement
- Transection of the Common Hepatic Duct (DHC):
- Perform laparotomy
- Attempt reanastomosis or create a biliodigestive anastomosis
- Uncertain Clip Closure:
- Use a Roeder loop for secure closure
- Guide the pre-fabricated loop with forceps, grasp the cystic stump, place the loop near the base, and cut it 5-7 mm above the knot
- Bleeding in the Common Hepatic Duct Bifurcation Area:
- Use careful bipolar high-frequency (HF) coagulation
- Compress and control bleeding with fibrin-coated collagen fleece
- For larger vessels: Apply clips or perform ligation
- For uncontrolled laparoscopic bleeding: Convert to laparotomy
- Bleeding from the Cystic Artery:
- Suction blood and position the suction tip at the perforation site
- Place a blind clip if the bleeding site is unclear, then aspirate and rinse to identify the site
- Apply a new targeted clip and remove the old one
- Ensure definitive identification of the cystic artery
- If identified, circumferentially dissect the vessel and place clips proximally and distally
- Bleeding from the Liver Bed:
- Use bipolar HF coagulation, compression, or ligation sutures
- Place a hemostatic agent (e.g., fibrin-coated collagen fleece), possibly combined with fibrin glue
- Diaphragm Perforation:
- Repair with sutures
- If necessary, perform laparotomy and place a Bülow drain
-
Intraoperative Complications and Management
Postoperative Complications
Biliary leakage: Biliary SecretionIf bile secretion is observed from the subhepatic drain or an inc
Biliary leakage: Biliary SecretionIf bile secretion is observed from the subhepatic drain or an inc
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