Procedures
Laparoscopic cholecystectomy
Complications
Laparoscopic cholecystectomy is generally safe, but the most serious complication -- bile duct injury -- can cause lifelong morbidity. Achieving the Critical View of Safety is the primary strategy for prevention.
| Complication | Timeframe | Mechanism | Presentation | Management |
|---|---|---|---|---|
| Bile duct injury (most feared) | Intraop or early postop | Misidentification of anatomy; failure to achieve Critical View of Safety | Bile leak, jaundice, abdominal pain, sepsis | Early recognition; specialist evaluation; reconstruction often required (e.g., hepaticojejunostomy) |
| Major bleeding | Intraoperative | Injury to cystic artery, right hepatic artery, or liver bed | Hemodynamic instability, poor visualization, expanding hematoma | Immediate control intraoperatively; may require transfusion or conversion |
| Bile leak (cystic stump or accessory duct) | Early postop (days) | Incomplete clip seal or accessory duct injury | RUQ pain, fever, bilious drain output, fluid collection | ERCP with stent +/- percutaneous drainage |
| Retained common bile duct stone | Early to weeks | Missed choledocholithiasis | Jaundice, pancreatitis, cholangitis | ERCP |
| Surgical site infection | Days to weeks | Contamination during extraction or port-site infection | Erythema, drainage, tenderness | Drainage when indicated; antibiotics for systemic illness or significant surrounding infection |
| Postoperative ileus | Early postop | Transient bowel dysmotility | Distension, nausea/vomiting, delayed flatus | Supportive care |