SUBCAPSULAR LIVER HEMATOMA – A COMPLICATION AFTER LAPAROSCOPIC CHOLECISTECTOMY

Subcapsular liver haematoma is among the most severe complications after laparoscopic cholecistectomy, but occurs rarely. The hematoma is usually located around the right lobe of the liver (in 75% of patients). We report the case of a 71 year old patient who underwent laparoscopic cholecistectomy for acute colecistitis. Initial postoperative evolution was favorable. On postoperative day 3 patient presents intense abdominal pain and decreased hemoglobin. The CT shows subcapsular hepatic hematoma. Emergency surgery is performed for signs of hemorragic shock with evacuation of the hematoma and hemostasis. Postoperative evolution is good. There are several theories proposed for the occurance of a subcapsular hematoma of the liver after laparoscopic cholecistectomy. Among these, the presence of a hemangioma, the use of NSAIDs or low molecular weight heparin. No clear mecanism is known and the only clinical sign can be abdominal pain. This case reminds us that we must take abdominal pain seriously after cholecystectomy in order to identify severe complications that can occur, such as hepatic subcapsular hematoma.

Total clipless cholecystectomy by means of harmonic sealing

BACKGROUND: In traditional laparoscopic cholecistectomy, the cystic duct and artery are commonly closed by metallic clips just before their division. Although the placement of these clips for occluding cystic artery and duct can be considered safe, biliary leaks and bleeding may occur especially by its dislodgement. AIM: To report a prospective case-series in total clipless cholecystectomy by means of harmonic shears for closure and division of the artery and cystic duct as well removal of the gallbladder from the liver. METHODS: Was evaluate a series of 125 patients who underwent laparoscopic cholecystectomy where the sealing and division of cystic artery and duct was carried out only by harmonic shears. The intact extracted gallbladder was submitted to a reverse pressure test for assessment of the technique safety by means of CO2 insuflation. RESULTS: The most common indication for surgery was gallstones. The mean operative time was 26 min and all gallbladders were dissected intact from the liver bed. There was no mortality and the overall morbidity rate was 0.8% with no hemorrhage or leaks. The reverse pressure test showed that all specimens support at least 36-mmHg of pressure without leaking. CONCLUSION: The harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time.

Embarazo y litiasis biliar. Especial referencia a la colecistectomía laparascópica

In this paper we review the indications of the laparoscopic cholecistectomy and other related methods in the diagnosis and treatment of cholelithiasis and choledocolithiasis during pregnancy. The epidemiology and ethiopathogenesis of biliary during pregnancy are also reviewed.