Laparoscopic cholecystectomy - Vascular and biliary complications

The aim of this study was to analyse the vascular and biliary complications on the first 361 laparoscopic cholecystectomies performed in a university digestive surgery unit. The rate of laparoscopic cholecystectomies increased from 17% in 1991 to 65% in 1995. The conversion rate was 18%. Laparoscopy was almost always converted for cholecystitis. Nine operative complications were observed, 6 hemorrhages, and 3 biliary complications with section of the common bile duct in one case. All these lesions were treated by laparotomy with good results. Six postoperative biliary complications were observed. Symptoms were pain (n = 6), fever (n = 2), jaundice (n = 1), and a choleperitoneum at ultrasound examination (n = 4). In one case a choleperitoneum was drained with an uneventful course. The other patients were reoperated (3 bile leakage of the cystic duct or the gallbladder plate, and 2 partial injuries of the common bile duct) with good results. Complication rates were higher in cholecystitis (P = 0,02) but were similar according to the experience of the surgeon. These results, similar to those of a British independent audit suggest than conversion and complication rates are higher than those reported in most of the multicentre studies. However, in all but one of the patients, the lesions were benign. The only common bile duct section was recognized at laparoscopy and repaired by open operation with a good result.