All surgery carries risk of serious complications including damage to nearby structures, bleeding, infection, or even death. The operative death rate in<unk>  is about 0.1% in people under age 50 and about 0.5% in people over age 50. The greatest risk of death comes from co-existing illness like cardiac or pulmonary disease. Biliary injury A serious complication of<unk>  is biliary injury, or damage to the bile ducts. Laparoscopic<unk>  has a higher risk of bile duct injury than the open approach, with injury to bile ducts occurring in 0.3% to 0.5% of laparoscopic cases and 0.1% to 0.2% of open cases. In laparoscopic<unk> , approximately 25-30% of biliary injuries are identified during the operation; the rest become apparent in the early post-operative period. Damage to the bile ducts is very serious because it causes leakage of bile into the abdomen. Signs and symptoms of a bile leak include abdominal pain, tenderness, fever and signs of sepsis several days following surgery, or through laboratory studies as rising total bilirubin and alkaline phosphatase. Complications from a bile leak can follow a person for years and can lead to death. Bile leak should always be considered in any patient who is not recovering as expected after<unk> . Most bile injuries require repair by a surgeon with special training in biliary reconstruction. If biliary injuries are properly treated and repaired, more than 90% of patients can have a long-term successful recovery. Injury of the bile ducts can be prevented and treated by routinely using X-ray investigation of the bile ducts (intraoperative<unk> ngiography (IOC)). This method was assessed by the Swedish SBU and routine use deemed to decrease risk of injury and morbidity following unaddressed injury while only increasing cancer rates due to radiation exposure by a lesser fraction. Other complications A review of safety data in laparoscopic<unk>  found the following complications to be most common: +Rates of complications other than bile duct injury after laparoscopic<unk>  Complication Prevalence Wound infection 1.25% Urinary retention 0.90% Bleeding 0.79% Retained stone in the common bile duct 0.50% Respiratory 0.48% Cardiac 0.36% Intra-abdominal abscess 0.34% Hernia 0.21% The same study found the prevalence of bowel injury, sepsis, pancreatitis, and deep vein thrombosis/pulmonary embolism to be around 0.15% each. Leakage from the stump of the cystic duct is a complication that is more common with the laparoscopic approach than the open approach but is still rare, occurring in less than 1% of procedures; it is treated by drainage followed by insertion of a bile duct stent. Another complication singular to the laparoscopic procedure is the phenomenon of the "spilled gallstone" which complicates 0.08%–0.3% of cases. Here a stone escapes the resected gallbladder into the abdomen where it can become a focus for infection if it is not identified and removed. Some reports exist of spilled stones lying unnoticed for up to 20 years before eventually causing an abscess to form. Conversion to open<unk>  Experts agree that many biliary injuries in laparoscopic cases are caused by difficulties seeing and identifying the anatomy clearly. If the surgeon has problems identifying anatomical structures, they might need to convert from laparoscopic to open<unk> . Peroperative Endoscopic Retrograde<unk> ngio-Pancreaticography (ERCP)/ Laparo-endoscopic rendezvous (LERV) technique CBDS are found in 10-15% of patients during<unk>  when intraoperative<unk> ngiography (IOC) is routinely performed. There are several strategies to manage<unk> docholithiasis but the optimal method as well as the timing of treatment is still under debate. In recent years the LERV technique, in which access to the common bile duct by ERCP is facilitated by an antegrade guidewire, which is intraoperatively introduced during fluoroscopy and is advanced through the cystic duct to the duodenum, has been established as an alternative to treat common bile duct stones discovered during laparoscopic<unk> . This technique was first described in 1993 by Deslandres et al. and has, in several studies, been shown to have a high rate of CBD stones clearance and a reduced number of complications, particularly post-ERCP pancreatitis, in comparison with conventional ERCP. This is probably due to the facilitated access to the common bile duct with a lesser degree of manipulation and trauma to the papilla Vateri. In a study by Swahn et al. the rendezvous method was shown to reduce the risk of PEP from 3.6 to 2.2% compared with conventional biliary cannulation. The success rate of passing the transcystic guidewire into the duodenum has been reported to be over 80%.
Cholecystectomy
Cholecystostomy
Cholecystenterostomy
Biliary endoscopic sphincterotomy
Endoscopic retrograde cholangiopancreatography
Perihepatic packing
Pancreatectomy
Appendectomy