B Aytaç1, S Cakar. 1. Department of General Surgery, TCDD Ankara Hospital, Turkey. bulentaytac2002@yahoo.com
Abstract
PURPOSE: Laparoscopic cholecystectomy (LC) has become the standard treatment for symptomatic cholelithiasis. The perforation of gallbladder, bile and stone spillage, trauma to bile duct are the most common complications of LC. This study was carried out to assess the outcome of gallbladder perforation (GBP) during LC. MATERIAL AND METHODS: Between 1991 and 2001, intraoperative GBP occurred in 48 patients during LC among 336 patients who were operated on for acute cholecystitis in 14, and for chronic cholecystitis in 322. RESULTS: Perforation was observed in 48 patients (14%). Perforation occurred during traction and grasping in 36 patients (75%), dissection of gallbladder in 8 patients (16%), and removal of the gallbladder in 4 patients (8%). Bile spillage occurred in 40 patients (83%) while bile and stone spillage was present in 8 patients (16%). During the follow-up period, a patient was diagnosed with a subhepatic abscess on the 15th postoperative day and percutaneous drainage was performed. CONCLUSIONS: During LC careful attention must be taken in order to prevent perforation, and the procedure must be performed by experienced surgeons with adequate instrumentations. If perforation occurs, extensive prompt retrieval of the bile and stone spillage must be done along with abundant irrigation. In case of inadequate aspiration and irrigation, the patients must be closely followed.
PURPOSE: Laparoscopic cholecystectomy (LC) has become the standard treatment for symptomatic cholelithiasis. The perforation of gallbladder, bile and stone spillage, trauma to bile duct are the most common complications of LC. This study was carried out to assess the outcome of gallbladder perforation (GBP) during LC. MATERIAL AND METHODS: Between 1991 and 2001, intraoperative GBP occurred in 48 patients during LC among 336 patients who were operated on for acute cholecystitis in 14, and for chronic cholecystitis in 322. RESULTS: Perforation was observed in 48 patients (14%). Perforation occurred during traction and grasping in 36 patients (75%), dissection of gallbladder in 8 patients (16%), and removal of the gallbladder in 4 patients (8%). Bile spillage occurred in 40 patients (83%) while bile and stone spillage was present in 8 patients (16%). During the follow-up period, a patient was diagnosed with a subhepatic abscess on the 15th postoperative day and percutaneous drainage was performed. CONCLUSIONS: During LC careful attention must be taken in order to prevent perforation, and the procedure must be performed by experienced surgeons with adequate instrumentations. If perforation occurs, extensive prompt retrieval of the bile and stone spillage must be done along with abundant irrigation. In case of inadequate aspiration and irrigation, the patients must be closely followed.