Bowel injuries during laparoscopic cholecystectomy

ABSTRACT

To determine the frequency, site, cause, presentation, management and mortality of the bowel injuries during laparoscopic cholecystectomy [LC]. Descriptive case-series. This is a prospective analysis of laparoscopic cholecystectomies performed at Surgical Unit I, Civil Hospital Karachi. A total of 1246 LCs were performed from 1st September 1997 to 15th June 2005. There were 1246 patients in the study, who underwent LC. The inclusion criteria for LC were patients of all ages and both sexes, symptomatic gallstone disease, recurrent attack while waiting for interval LC, normal levels of blood complete picture and liver function tests, and ultrasound abdomen demonstrating gallstone disease. There were 2 cases of bowel injury, ie a frequency of 0.16%. One was serosal injury to colon and the other was duodenal perforation. Both were detected peroperatively, and managed by converting the procedure to open and primary closure of injury; duodenal closure was reinforced with omental patch. Postoperatively, the patient with colonic injury recovered well, but the patient with duodenal injury developed duodenal fistula which was managed conservatively. There was no mortality. Both cases of bowel injury were among the first 50 of the 1246 case-series. At 0.16%, the frequency of bowel injuries during laparoscopic cholecystectomy is small; the risk of such injury is more during the learning curve. Timely detection during the operation results in successful outcome, with little or no mortality