COMPLICATIONS FOLLOWING CHOLECYSTECTOMY

Laparoscopic cholecystectomy is considered the gold standard for chole lithiasis. Nevertheless possible complications must not be underestima ted. In this department, from 1 July 1991 to 30 November 1995, 1005 pa tients with cholelithiasis underwent videocholecystectomy. There was n o peri-operative mortality. In 36 cases (3.6%) the procedure was chang ed to laparotomy. In four cases (0.4%) conversion was mandatory due to severe complications: in three patients while introducing a trocar (o ne aortic lesion, one middle colic vein injury and one visceral perfor ation) and in one patient due to bleeding in the hepatic hilar region. In 32 cases (3.2%) conversion was carried out electively. This was du e to technical difficulties or to choledocholithiasis (22 patients), a naesthesiological problems (three cases), biliodigestive fistula (one) , bile spillage from accessory hepatic ducts (three), unexpected colon ic cancer (one), instrument malfunction (two cases). Twenty-four patie nts (2.4%) experienced post-operative complications: one with pneumoth orax, two with bile leakage (one bile duct damage, and one cystic duct leakage), eight with haemoperitoneum, five with subphrenic abscess, t hree with anaemia, three with intraparietal collections, one with bila teral basal bronchopneumonia, one with perforated duodenal stress ulce r. Of these, 11 patients (1%) underwent reintervention: five re-laparo scopies, three conversions, and three open laparotomies. This study de monstrates the safety of videoalparocholecystectomy. Complications are relatively rare and can be often dealt with conservative treatment or re-laparoscopy. Complications are often linked to insertion of a blin d trocar or to the induction of a closed pneumoperitoneum. Meticulous technique or open laparoscopy minimize these risks. Conversion must no t be considered a defeat but a wise decision in the face of major diff iculties. Under these principles, videocholecystectomy is safe and rep resents the best treatment of gallbladder stones.