Surgically repaired severe post-cholecystectomy complications and their management
Nurkan Törer, Tarık Zafer Nursal, Kenan Çalışkan, Ali Ezer, Tamer Çolakoğlu, Hamdi Karakayalı, Mehmet Haberal
Başkent Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı, Ankara
Abstract
Background: We aim to share our experience on major complications of cholecystectomy.
Methods: Records of patients operated for major cholecystectomy complications between May 1999 - November 2007 were analyzed. Type of cholecystectomy, clinical complaint, type of injury, period from first operation to referral and referral to corrective surgery, postoperative complications and long-term outcome were recorded.
Results: Median age of 22 patients was 50 (27 – 73), female/male ratio was 1.2. Type of cholecystectomy was laparoscopic cholecystectomy (LC) (n=9), open cholecystectomy (OC) (n=8), bilioenterostomy (due to post-cholecystectomy benign biliary stricture) (n=2), conversion to open cholecystectomy (COC) (n=3). Detected type of injury was; Type-B (n=7), Type-C (n=11), Type-D (n=3) and unclassified (n=1) according to Amsterdam classification. All of the Type-B injuries were observed in four LC and three COC patients and none of the OC patients. However, in the OC group, most frequent type of injury was Type-C (n=6/8) (p=0.029).
One patient died, 7 patients had complication, and two patients had recurrent biliary problems. Complication rate was more frequent for; Type-D injury (2/3 p=0.167), patients with early (<10 days) presentation (5/9 - 2/13) (p=0.046) and patients with early (<10 days) surgical intervention (6/13 - 1/9) (p=0.069). Experiencing recurrent problem rate was more frequent for the patients with early surgical intervention (2/12 – 0/9) (p=0.178).
Conclusion: Most frequent complication of OC was biliary strictures and that of LC was bile leakage.
Keywords: Cholecystectomy, biliary injury, surgical repair