Routine ultrasound and blood tests after laparoscopic cholecystectomy-are they worthwhile? A diagnostic accuracy study

Routine postoperative blood tests fail to reliably predict procedure-related complications after laparoscopic cholecystectomy

Purpose

Laparoscopic cholecystectomy is a highly standardized surgical procedure with a low risk of complications. However, once complications develop, they can be life-threatening. The aim of this study was to evaluate the value of blood tests on postoperative day one regarding their potential to predict postoperative complications

Methods

A cohort study of 1706 consecutive cholecystectomies performed at a tertiary hospital and teaching facility over a 5-year period between 2014 and 2019.

Results

Patients that had open CCE or conversion CCE were excluded. One thousand five hundred eighty-six patients were included in the final analysis that received a laparoscopic cholecystectomy (CCE). One thousand five hundred twenty-three patients had blood tests on POD 1. Forty-one complications were detected including 14 bile leaks, 2 common bile duct injuries, 13 choledocholithiasis, 9 hematomas, and 2 active bleedings. Bilirubin was elevated in 351 patients on POD 1. A drop of more than 3 mg/dl of hemoglobin was reported in 39 patients. GPT was elevated 3 × above the upper limit in 102 patients. All three tests showed a low sensitivity and specificity in detecting postoperative complications.

Conclusions

Early postoperative blood tests alone show a low specificity in detecting postoperative complications after laparoscopic CCE. Their main benefit appears to be the negative predictive value, when they are normal. Routine blood testing appears to be unnecessary and should be based on the intraoperative diagnosis and postoperative clinical findings.

Are routine ultrasound examinations helpful in the detection of bleeding complications following laparoscopic inguinal hernia repair?

PURPOSE

Intraabdominal bleeding is a dreaded complication after laparoscopic transabdominal preperitoneal inguinal hernia repairs. Routine postoperative sonographic (US) examination and hemoglobin measurement have been suggested to identify bleeding after surgery. We retrospectively assessed the value of these tests.

METHODS

A total of 995 consecutive patients admitted for laparoscopic inguinal hernia repair to a single teaching hospital were analyzed. US examinations were performed postoperatively on the operative day to identify intraabdominal bleeding. In addition, hemoglobin measurements were obtained on the first postoperative day.

RESULTS

Postoperative US examinations were performed on 971 patients (97.6%). Of these, 945 were examined within 24 hours of surgery. Reoperation was necessary in 1.1% (11/995) of the patients because of a persistent seroma in five cases, intraabdominal or inguinal bleeding or hematomas in five cases, and a trocar hernia in one case. In none of the 11 patients requiring reoperation did US examination or hemoglobin measurement indicate acute bleeding or hematoma.

CONCLUSIONS

Routine postoperative US examination and hemoglobin measurement within the first 24 hours of surgery are not suitable for identifying patients with intraabdominal bleeding who require a reoperation. Instead, US examination and hemoglobin measurement should be part of the patient workup when there is a clinical suspicion of a postoperative complication. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:145-149, 2017.