Unexpected bleeding during laparoscopic cholecystectomy: a hepatic vein injury

Vascular injury during laparoscopic cholecystectomy: An often-overlooked complication

Laparoscopic cholecystectomy is one of the most frequently performed procedures in gastrointestinal surgery worldwide. Bleeding complications due to vascular injuries represent an important cause of morbidity and mortality, especially when facing major bleeding during laparoscopy, where bleeding control can be technically challenging in inexperienced hands. Interestingly, the reported incidence rate of conversion to open surgery due to vascular lesions is approximately 0%-1.9%, with a mortality rate of approximately 0.02%. The primary aim of this article was to perform an up-to-date overview regarding the incidence and surgical management of vascular injuries during laparoscopic cholecystectomy according to the available scientific evidence.

Management of Postcholecystectomy Complications

Cholecystectomy is one of the most common general surgery procedures performed worldwide. Complications include bile duct injury, strictures, bleeding, infection/abscess, retained gallstones, hernias, and postcholecystectomy syndrome. Obtaining a critical view of safety and following the other tenets of the Safe Cholecystectomy Task Force will aid in the prevention of bile duct injury and other morbidity associated with cholecystectomy.

Management of Middle Hepatic Vein Injury during Laparoscopic Cholecystectomy: A Case Report

Background  Cholecystectomy continues to be the first choice for the treatment of symptomatic cholelithiasis. Especially in patients with acute cholecystitis, a laparoscopic approach has become the standard treatment option. Intraoperative complications of laparoscopic cholecystectomy include: bile duct injury, organ damage, and bleeding due to vascular injury. Difficult hemorrhage during laparoscopic cholecystectomy occurs in 0.1 to 1.9% of all cases. Besides major vessel injuries, gallbladder bed vasculature is reported as a common injury site, mostly secondary to middle hepatic vein lesions.

Case Presentation  We present a case report of a patient taken for a laparoscopic cholecystectomy. During the procedure, inadvertent middle hepatic vein injury occurs. Here we describe the management approach selected for this type of injury.

Discussion  We recommend careful dissection during the final steps of a laparoscopic cholecystectomy. Following cystic duct and cystic artery ligation, surgeons often inappropriately relax through the last part of the dissection. During this final dissection, if care is not taken, small vascular structures can be missed and injured.