Complications of Laparoscopic Cholecystectomy: Our Experience from a Retrospective Analysis

  • Miodrag Radunovic Faculty of Medicine, University of Montenegro, Podgorica
  • Ranko Lazovic Center for General and Digestive surgery, Clinical Centre of Montenegro, Podgorica
  • Natasa Popovic Faculty of Medicine, University of Montenegro, Podgorica
  • Milorad Magdelinic Clinic for General Surgery, General Hospital Berane, Berane
  • Milutin Bulajic Clinic for Gastroenterology, Clinical Centre of Belgrade, University of Belgrade, Belgrade
  • Lenka Radunovic General Medical Health, Primary Health Care Berane, Berane
  • Marko Vukovic Urology and Nephrology Clinic, Clinical Centre of Montenegro, Podgorica
  • Miroslav Radunovic Faculty of Medicine, University of Montenegro, Podgorica
Keywords: Laparoscopy, cholecystectomy, cholelithiasis


AIM: The aim of this study was to evaluate the intraoperative and postoperative complications of laparoscopic cholecystectomy, as well as the frequency of conversions.

MATERIAL AND METHODS: Medical records of 740 patients who had laparoscopic cholecystectomy were analysed retrospectively. We evaluated patients for the presence of potential risk factors that could predict the development of complications such as age, gender, body mass index, white blood cell count and C-reactive protein (CRP), gallbladder ultrasonographic findings, and pathohistological analysis of removed gallbladders. The correlation between these risk factors was also analysed.

RESULTS: There were 97 (13.1%) intraoperative complications (IOC). Iatrogenic perforations of a gallbladder were the most common complication - 39 patients (5.27%). Among the postoperative complications (POC), the most common ones were bleeding from abdominal cavity 27 (3.64%), biliary duct leaks 14 (1.89%), and infection of the surgical wound 7 patients (0.94%). There were 29 conversions (3.91%). The presence of more than one complication was more common in males (OR = 2.95, CI 95%, 1.42-4.23, p < 0.001). An especially high incidence of complications was noted in patients with elevated white blood cell count (OR = 3.98, CI 95% 1.68-16.92, p < 0.01), and CRP (OR = 2.42, CI 95% 1.23-12.54, p < 0.01). The increased incidence of complications was noted in patients with ultrasonographic finding of gallbladder empyema and increased thickness of the gallbladder wall > 3 mm (OR = 4.63, CI 95% 1.56-17.33, p < 0.001), as well as in patients with acute cholecystitis that was confirmed by pathohistological analysis (OR = 1.75, CI 95% 2.39-16.46, p < 0.001).

CONCLUSION: Adopting laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay. It is important recognising IOC complications during the surgery so they are taken care of in a timely manner during the surgical intervention. Conversion should not be considered a complication.



Download data is not yet available.


Metrics Loading ...

Plum Analytics Artifact Widget Block


Mc Kinley SK, Brunt LM, Schwaitzberg SD. Prevention of bile injury: the case for incorporating educational theories of expertise. Surg Endosc. 2014; 28:3385-91. PMid:24939158

Larobina M, Nottle P. Complete evidence regrading major vascular injuries during laparoscopic access. Surg laparosc Endosc Percutan Tech. 2005; 15:119-23. PMid:15956893

Fuller J, Ashar BS, Carey-Corrado J. Trocar-associated injuries and fatalities: an analysis of 1399 reports to the FDA, J Minim Invasive Gynecol. 2005; 12:302-7. PMid:16036187

Strasberg SM, Herti M, Soper Nj. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995; 180:101-25. PMid:8000648

Frilling A, Li J, Weber F, Fruhans NR et al. Major bile duct injuries after laparoscopic cholecystectomy: a tertiary center experience. J Gastrointes Surg. 2004; 8:679-85. PMid:15358328

Singh K, Ohri A. Anatomic landmarks: their usefulness in safe laparoscopic cholecystectomy. Surg Endosc. 2006; 20:1754-8. PMid:17001444

Kaushik R. Bleeding complications in laparoscopic cholecystectomy: incidence, mechanisms, prevention and management. J Minim Access Surg. 2010; 6:59-65. PMid:20877476 PMCid:PMC2938714

Duca S, Bala O, Al-Hajjar N, Iancu C, Puja IC, Munteanu D, Graur F. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations HPB(Oxford). 2003; 5:152-58.

Nuzzo G, Guiliante F, Giovannini I et al. Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56591 cholecystectomies. Arch Surg. 2005; 140:986-92. PMid:16230550

Diamantis T, Tsigris C, Kiriakopoulos A, et al. Bile duct injuries associated with laparoscopic and open cholecystectomy: an 11- year experience in one institute. Surg Today. 2005; 35:841-5. PMid:16175465

Kholdebarin R, Boetto J, Harnish JL et al. Risk factors for bile duct injury during laparoscopic cholecystectomy: a case - control study. Surg Innov. 2008; 74:985-7.

Yang TF, Guo L,Wang Q. Evaluation of preoperative risk factors for converting laparoscopic to open cholecystectomy: a meta analysis. Hepatogastroenterology. 2014; 61:958-65. PMid:26158149

Simopoulos C, Botaitis S, Polychronidis A et al. Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surg Endosc. 2005; 19:905. PMid:15868267

Stanisic V, Milicevic M, Kocev N et al. Prediction of difficulties in laparoscopic cholecystectomy on the base of routinely available parameters in a smaller regional hospital. Eur Rev Med Pharmacol. 2014; 18:1204-1211.

Shamiyeh A, Wayand W. Laparoscopic cholecystectomy early and late complications and their treatment. Langenbecks Arch Surg. 2004; 389:164-71. PMid:15133671

Tantia O, Jain M, Khanna S et al. Iatrogenic biliary injury: 13305 cholecystectomies experienced by a single surgical team over more than 13 years. Surg Endosc. 2008; 22:1077-86. PMid:18210186

Z'graggen K, Wehrli H, Metzger A,et al. Complications of laparoscopic cholecystectomy in Switzerland. A prospective 3- year study of 10174 patients. Swiss Association of Laparoscopic and Thoracoscopic Surgery. Surg Endosc. 1998; 12:1303. PMid:9788852

Singh R, Kaushik R, Sharma R et al. Non- biliary mishaps during laparoscopic cholecystectomy. Ind J Gastroenterol. 2004; 23:47-9 PMid:15176534

Phillips PA, Amaral JF. Abdominal access complications in laparoscopic surgery. J Am Coll Surg. 2001; 192:525-36.

Marakis G, Pavidis TE, Aimoniotou E et al. Major complications during laparoscopic cholecystectomy. Int Surg. 2007; 92:142-6. PMid:17972469

Opitz I, Gantert W, Giger U et al. Bleeding remains a major complication during laparoscopic surgery:Analysis of the SALTS database. Langenbeck's Arch Surg. 2005; 390:128-33. PMid:15700192

Bhoyrul S, Vierra MA, Nezhalt CR et al. Trocar injuries in laparoscopic surgery. J Am Collsurg. 2001; 192:672-83.

Schafer M, Lauper M, Krahenbuhl L. A nation's experience of bleeding complications during laparoscopy. Am J Surg. 2000; 180:7307.

Virupaksha S. Consequences of spilt gallstones during laparoscopic cholecystectomy. Indian J Surg. 2014; 76:95-9. PMid:24891771 PMCid:PMC4039679

Loffeld RJ. The consequences of lost gallstones during laparoscopic cholecystectomy. Neth J Med. 2006; 64:364-6. PMid:17122452

Dasari BVM, Loan W, Carey DP. Spilled gall-stones mimicking peritoneal metastases. JSLS. 2009; 13:73-6. PMid:19366546 PMCid:PMC3015906

ZehenterJ, Shamiyech A, Wayand W. Lost gallstones in laparoscopic cholecystectomy: all possible complications. Am J Surg. 2007; 193:73-8. PMid:17188092

Leduc Lj, Metchell A. Intestinal ischemia after laparoscopic cholecystectomy. JSLS. 2006; 10:236-8. PMid:16882427 PMCid:PMC3016113

Baldassarre GE, Valenti G, Torino G et al. Small bowel evisceration after laparoscopic cholecystectomy: report of an unusual case. Minerva Chir. 2006; 6:167-9.

Boni L, Benevento A, Rovera F et al: Infective complications in laparoscopic surgery. Surg Infect / Larchnet. 2006;7 (Suppl 2):5109-11

Chuang SC,Lee KT, Chang NT et al. Risk factors for wound infection after cholecystectomy. J Formos Med Asso. 2004;103.

Bunting DM, Port-site hernia following laparoscopic cholecystectomy. JSLS. 2010; 14:490-97. PMid:21605509 PMCid:PMC3083037

Agaba EA, Rainville H, Wemulapali P. Incidence of port-site incisional hernia after single- incisional surgery. JSLS. 2014; 18:204-10. PMid:24960483 PMCid:PMC4035630

Zhang WJ, Li JM, Wu GZ et al. Risk factors affecting conversion in patients undergoing laparoscopic cholecystectomy. ANZ J Surg. 2008; 78:973-6. PMid:18959695

How to Cite
Radunovic M, Lazovic R, Popovic N, Magdelinic M, Bulajic M, Radunovic L, Vukovic M, Radunovic M. Complications of Laparoscopic Cholecystectomy: Our Experience from a Retrospective Analysis. Open Access Maced J Med Sci [Internet]. 2016Nov.9 [cited 2020Nov.1];4(4):641-6. Available from:
B - Clinical Sciences