Vascular injury during laparoscopic cholecystectomy: An often-overlooked complication

Abstract

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.

Keywords: Laparoscopic cholecystectomy; Specialized hepatobiliary centers; Surgical management; Vascular anomalies; Vascular injury.

Figure 1

Anatomic illustration of the most common variants of cystic artery. Common variants of cystic artery. A: Cystic artery originating from the right hepatic artery in the classical position[6-8]; B: Long cystic artery seen anteriorly to the cystic duct[6,7]; C: Cystic artery coming from the gastroduodenal artery, passing outside Calot’s triangle[6,9]; D: Long single cystic artery not from the right hepatic artery crossing anterior to the common hepatic duct[6,9]. RHA: Right hepatic artery; LHA: Left hepatic artery; PHA: Proper hepatic artery; CHA: Common hepatic artery; GDA: Gastroduodenal artery; G: Gallbladder; CHD: Common hepatic duct; CD: Cystic duct; CBD: Common bile duct; RHD: Right hepatic duct; LHD: Left hepatic duct; AA: Abdominal aorta.