Avoidance of Complications in Laparoscopic Cholecystectomy

Cholecystectomy for cholelithiasis is a commonly performed procedure. More than 500,000 cholecystectomies are done every year in the United States alone.1 Laparoscopic cholecystectomy is presently the surgical procedure of choice for most patients with symptomatic cholelithiasis. For a trained surgeon with good equipment and assistance, laparoscopic cholecystectomy can be a quick and easy procedure; however, it can also be a nightmare where just about every step can be difficult and go wrong. The list of complications reported during laparoscopic cholecystectomy is long, but most of the complications reported are minor and, when compared with open cholecystectomy, the total number is much lower.1–6 The incidence of extrahepatic bile duct injuries, however, which is the worst complication of a cholecystectomy, increased significantly with the introduction of laparoscopic cholecystectomy.2,7–11 This increase in the incidence of bile duct injuries raised the concerns of surgeons as well as of health authorities. Several surgeons and institutions have subsequently published guidelines for the training for and the performance of laparoscopic cholecystectomy.1,7,12–14 The data supports the view that bile duct injuries mostly occur early in a surgeon’s experience and that they are associated with the learning curve for laparoscopic cholecystectomy.1,15 The incidence of bile duct injury seems to be decreasing, and there are suggestions that the pattern of injury may be changing.8,15,16 By identifying these problems and by analyzing how, why, and when they occur, several authors have come up with a list of preventive measures to avoid complications during laparoscopic cholecystectomy.1,6,7,9,12,14,16–19