Hepatic vein injury during laparoscopic cholecystectomy: The unappreciated proximity of the middle hepatic vein to the gallbladder bed |
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Authors: | Chad G Ball MD MSc Anthony R MacLean MD Andrew W Kirkpatrick MD Oliver F Bathe MD Francis Sutherland MD Estifanos Debru MD Elijah Dixon MD |
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Institution: | (1) From the Department of Surgery, Foothills Medical Centre, Calgary, Alberta, Canada;(2) Peter Lougheed Hospital, Calgary, Alberta, Canada;(3) Divisions of General Surgery and Surgical Oncology, Faculty of Medicine, University of Calgary, Tom Baker Cancer Center, 1331 29th Street NW, T2N 2N4 Calgary, Alberta, Canada |
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Abstract: | Uncontrollable hemorrhage during laparoscopic cholecystectomy occurs in 0.1% to 1.9% of all cases, with 88% originating from
the gallbladder bed. The anatomical proximity between major branches of the middle hepatic vein and the gallbladder bed, and
hence the risk of intraoperative bleeding, is unclear. CT scans of 20 random patients were retrospectively reviewed to identify
the closest distance between branches of the middle hepatic vein and the gallbladder bed. The vein diameter was also recorded.
Risk factors for intraoperative bleeding during laparoscopic cholecystectomy were also retrospectively reviewed. Large branches
(mean diameter=2.1 mm) of the middle hepatic vein are directly adjacent to the gallbladder bed in 10% of patients. An additional
10% of cases also possess branches within 1 mm of the gallbladder bed. Chronically scarred and contracted gallbladder disease
may increase the risk of significant bleeding, requiring conversion. Twenty percent of all cases will display a large branch
of the middle hepatic vein adherent or immediately adjacent to the gallbladder fossa. These patients are at increased risk
for intraoperative bleeding. Furthermore, contracted gallbladders with evidence of chronic disease may be at increased risk
for significant hemorrhage. |
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Keywords: | Laparoscopic cholecystectomy hepatic vein hemorrhage |
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