Non-biliary mishaps during laparoscopic cholecystectomy.
BACKGROUND
The most important complications of laparoscopic cholecystectomy (LC) are biliary tract injuries. Non-biliary complications can be equally devastating, but have received less attention in literature.


METHODS
The case files of 1748 patients who underwent LC over a period of seven years (1997-2003) in our department were retrospectively reviewed to identify non-biliary complications and their management.


RESULTS
Nine patients (0.5%) sustained significant non-biliary injury while undergoing LC. The commonest was duodenal perforation during dissection of the Calot's triangle (3 cases). Other complications included diaphragmatic injury (2 cases), and small bowel injury while inserting the umbilical port, right external iliac artery injury during insertion of Veress needle, portal vein injury during dissection, and liver laceration while using a delivery system to extract the gall bladder (1 each). All these complications were detected and managed intra-operatively. During the same period, 10 patients sustained biliary injury.


CONCLUSIONS
Intra-operative non-biliary injuries during LC occur as frequently as biliary injuries, and can be life-threatening and difficult to manage.
Singh
Rajdeep
R
Department of Surgery, Government Medical College and Hospital, Sector 32, Chandigarh 160 030. rajdeep2000@hotmail.com
Kaushik
Robin
R
Sharma
Rajeev
R
Attri
Ashok K
AK
D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D002764:Cholecystitis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000293:injuries; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology; D011169:Portal Vein / Q000293:injuries; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies