ĐÁNH GIÁ TAI BIẾN VÀ BIẾN CHỨNG CỦA PHẪU THUẬT NỘI SOI ĐIỀU TRỊ VIÊM TÚI MẬT CẤP DO SỎI TẠI BỆNH VIỆN NGUYỄN TRÃI

Abstract

Introduction: Acute cholecystitis is an acute infection of the gallbladder, most commonly caused by gallstones (90-95%)¹. It is a common surgical emergency. If not diagnosed and treated promptly, it can lead to complications such as necrotic cholecystitis, suppuration, peritonitis, sepsis, and even death. Laparoscopic surgery is increasingly used to treat acute cholecystitis caused by gallstones and is currently the first-choice surgical treatment. Although laparoscopic cholecystectomy offers many benefits, it also carries complications, ranging from severe to less severe. This study aims to clarify the complications and adverse events associated with laparoscopic cholecystectomy for the treatment of acute cholecystitis caused by gallstones over a 5-year period (from January 1, 2016, to December 31, 2020) at Nguyen Trai Hospital. Objectives: To determine the rate of complications and adverse events associated with laparoscopic cholecystectomy, and to examine the relationship between factors related to complications and severe complications of laparoscopic cholecystectomy for acute cholecystitis due to gallstones. Methods: A cross-sectional descriptive study was conducted on 249 patients admitted to the General Surgery Department of Nguyen Trai Hospital, all of whom were diagnosed with acute cholecystitis due to gallstones and underwent laparoscopic cholecystectomy between January 1, 2016, and December 31, 2020. Results: The results showed that 100 cases (40.16%) experienced complications and adverse events, of which 14 cases (5.6%) had severe complications. Mild complications, including gallbladder perforation, bile leakage, and stones in the abdominal cavity, had the highest rate at 15.2%, followed by bleeding (from the abdominal wall at the trocar hole and from the gallbladder bed), which accounted for 11.2%. Serious complications included bleeding requiring open surgery to stop the hemorrhage and biliary tract injury, both of which accounted for the largest number at 2.0%, followed by bile leakage at 1.2%. The results also showed a correlation between complications and severe complications with the following factors: gender, characteristics of intermittent abdominal pain, diagnosis based on ultrasound and CT scan results, gallbladder and hepatic pedicle edema-adhesions, and gallbladder wall necrosis. Conclusion: Severe complications and adverse events occur more frequently in individuals with the following characteristics: male gender, intermittent abdominal pain, and ultrasound or computed tomography findings suggestive of acute or chronic inflammation, along with edema, adhesions, and necrosis in the gallbladder and hepatic pedicle area. During surgery, it is crucial to ensure careful dissection in cases of acute cholecystitis, as laparoscopic cholecystectomy requires precise identification of the anatomy of the hepatobiliary triangle to avoid serious complications