Complications of Laparoscopic Cholecystectomy: Our Experience from a Retrospective Analysis

Overview

Journal Open Access Maced J Med Sci

Specialty General Medicine

Date 2016 Dec 29

PMID 28028405

Citations 27

Authors

Miodrag Radunovic

Ranko Lazovic

Natasa Popovic

Milorad Magdelinic

Milutin Bulajic

Lenka Radunovic

Marko Vukovic

Miroslav Radunovic

Affiliations

Soon will be listed here.

Abstract

Aim: The aim of this study was to evaluate the intraoperative and postoperative complications of laparoscopic cholecystectomy, as well as the frequency of conversions.

Material And Methods: Medical records of 740 patients who had laparoscopic cholecystectomy were analysed retrospectively. We evaluated patients for the presence of potential risk factors that could predict the development of complications such as age, gender, body mass index, white blood cell count and C-reactive protein (CRP), gallbladder ultrasonographic findings, and pathohistological analysis of removed gallbladders. The correlation between these risk factors was also analysed.

Results: There were 97 (13.1%) intraoperative complications (IOC). Iatrogenic perforations of a gallbladder were the most common complication - 39 patients (5.27%). Among the postoperative complications (POC), the most common ones were bleeding from abdominal cavity 27 (3.64%), biliary duct leaks 14 (1.89%), and infection of the surgical wound 7 patients (0.94%). There were 29 conversions (3.91%). The presence of more than one complication was more common in males (OR = 2.95, CI 95%, 1.42-4.23, p < 0.001). An especially high incidence of complications was noted in patients with elevated white blood cell count (OR = 3.98, CI 95% 1.68-16.92, p < 0.01), and CRP (OR = 2.42, CI 95% 1.23-12.54, p < 0.01). The increased incidence of complications was noted in patients with ultrasonographic finding of gallbladder empyema and increased thickness of the gallbladder wall > 3 mm (OR = 4.63, CI 95% 1.56-17.33, p < 0.001), as well as in patients with acute cholecystitis that was confirmed by pathohistological analysis (OR = 1.75, CI 95% 2.39-16.46, p < 0.001).

Conclusion: Adopting laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay. It is important recognising IOC complications during the surgery so they are taken care of in a timely manner during the surgical intervention. Conversion should not be considered a complication.

Citing Articles

Evaluating risk factors for surgical site infections and the effectiveness of prophylactic antibiotics in patients undergoing laparoscopic cholecystectomy.

Wang S World J Gastrointest Surg. 2025; 17(1):98567.

PMID: 39872773 PMC: 11757180. DOI: 10.4240/wjgs.v17.i1.98567.

What happens after percutaneous cholecystostomy tube for acute calculous cholecystitis?.

Cruz-Centeno N, Jovet-Toledo G, Ramirez-Tanchez C Surg Pract Sci. 2025; 10():100121.

PMID: 39845608 PMC: 11749936. DOI: 10.1016/j.sipas.2022.100121.

Factors Influencing the Achievement of the Critical View of Safety in Laparoscopic Cholecystectomy: A Prospective Observational Study in Yemen.

Alnoor A, Obadiel Y, Saleh K, Jowah H Cureus. 2025; 16(12):e76222.

PMID: 39845232 PMC: 11751102. DOI: 10.7759/cureus.76222.

Comparison of Current Techniques for Securing the Cystic Duct in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis.

Verani L, Murateva Y, Muscat N, Dintakurti S, Shah S, Alkhazaaleh O Cureus. 2025; 16(12):e75787.

PMID: 39816287 PMC: 11733803. DOI: 10.7759/cureus.75787.

A case of mistaken identity: Gallstone-induced hepatic abscess mimicking metastasis.

Kamburoglu M, Buzkan I, Muhtaroglu A, Akdeniz Y, Altintoprak F Ulus Travma Acil Cerrahi Derg. 2024; 30(11):839-841.

PMID: 39498707 PMC: 11843384. DOI: 10.14744/tjtes.2024.28369.

References

Schafer M, Lauper M, Krahenbuhl L . A nation's experience of bleeding complications during laparoscopy. Am J Surg. 2000; 180(1):73-7. DOI: 10.1016/s0002-9610(00)00416-5. View

Philips P, Amaral J . Abdominal access complications in laparoscopic surgery. J Am Coll Surg. 2001; 192(4):525-36. DOI: 10.1016/s1072-7515(01)00768-2. View

Bhoyrul S, Vierra M, Nezhat C, Krummel T, Way L . Trocar injuries in laparoscopic surgery. J Am Coll Surg. 2001; 192(6):677-83. DOI: 10.1016/s1072-7515(01)00913-9. View

Shamiyeh A, Wayand W . Laparoscopic cholecystectomy: early and late complications and their treatment. Langenbecks Arch Surg. 2004; 389(3):164-71. DOI: 10.1007/s00423-004-0470-2. View

Singh R, Kaushik R, Sharma R, Attri A . Non-biliary mishaps during laparoscopic cholecystectomy. Indian J Gastroenterol. 2004; 23(2):47-9. View

Chuang S, Lee K, Chang W, Wang S, Kuo K, Chen J . Risk factors for wound infection after cholecystectomy. J Formos Med Assoc. 2004; 103(8):607-12. View

Frilling A, Li J, Weber F, Fruhauf N, Engel J, Beckebaum S . Major bile duct injuries after laparoscopic cholecystectomy: a tertiary center experience. J Gastrointest Surg. 2004; 8(6):679-85. DOI: 10.1016/j.gassur.2004.04.005. View

Opitz I, Gantert W, Giger U, Kocher T, Krahenbuhl L . Bleeding remains a major complication during laparoscopic surgery: analysis of the SALTS database. Langenbecks Arch Surg. 2005; 390(2):128-33. DOI: 10.1007/s00423-004-0538-z. View

Simopoulos C, Botaitis S, Polychronidis A, Tripsianis G, Karayiannakis A . Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surg Endosc. 2005; 19(7):905-9. DOI: 10.1007/s00464-004-2197-0. View

10.

Larobina M, Nottle P . Complete evidence regarding major vascular injuries during laparoscopic access. Surg Laparosc Endosc Percutan Tech. 2005; 15(3):119-23. DOI: 10.1097/01.sle.0000166967.49274.ca. View

11.

Fuller J, Ashar B, Carey-Corrado J . Trocar-associated injuries and fatalities: an analysis of 1399 reports to the FDA. J Minim Invasive Gynecol. 2005; 12(4):302-7. DOI: 10.1016/j.jmig.2005.05.008. View

12.

Diamantis T, Tsigris C, Kiriakopoulos A, Papalambros E, Bramis J, Michail P . Bile duct injuries associated with laparoscopic and open cholecystectomy: an 11-year experience in one institute. Surg Today. 2005; 35(10):841-5. DOI: 10.1007/s00595-005-3038-z. View

13.

Nuzzo G, Giuliante F, Giovannini I, Ardito F, DAcapito F, Vellone M . Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. Arch Surg. 2005; 140(10):986-92. DOI: 10.1001/archsurg.140.10.986. View

14.

Baldassarre G, Valenti G, Torino G, Prosperi Porta I, Valenti V, Campisi C . Small bowel evisceration after laparoscopic cholecystectomy: report of an unusual case. Minerva Chir. 2006; 61(2):167-9. View

15.

Leduc L, Mitchell A . Intestinal ischemia after laparoscopic cholecystectomy. JSLS. 2006; 10(2):236-8. PMC: 3016113. View

16.

Boni L, Benevento A, Rovera F, Dionigi G, Di Giuseppe M, Bertoglio C . Infective complications in laparoscopic surgery. Surg Infect (Larchmt). 2006; 7 Suppl 2:S109-11. DOI: 10.1089/sur.2006.7.s2-109. View

17.

Singh K, Ohri A . Anatomic landmarks: their usefulness in safe laparoscopic cholecystectomy. Surg Endosc. 2006; 20(11):1754-8. DOI: 10.1007/s00464-005-0528-4. View

18.

Loffeld R . The consequences of lost gallstones during laparoscopic cholecystectomy. Neth J Med. 2006; 64(10):364-6. View

19.

Zehetner J, Shamiyeh A, Wayand W . Lost gallstones in laparoscopic cholecystectomy: all possible complications. Am J Surg. 2006; 193(1):73-8. DOI: 10.1016/j.amjsurg.2006.05.015. View

20.

Marakis G, Pavlidis T, Ballas K, Aimoniotou E, Psarras K, Karvounaris D . Major complications during laparoscopic cholecystectomy. Int Surg. 2007; 92(3):142-6. View