Laparoscopic cholecystectomy and the Peter Pan syndrome

• Published in: Surgical endoscopy Vol. 14; no. 8; pp. 767 - 768
• Main Authors: Orlando, G, Bellini, P, Borioni, R, Pace, A
• Format: Journal Article
• Language: English
• Published: Germany 01.08.2000
• Subjects: Biliary Fistula - etiology; Biliary Fistula - surgery; Cholecystectomy, Laparoscopic - adverse effects; Cholecystectomy, Laparoscopic - methods; Cholecystectomy, Laparoscopic - standards; Cholelithiasis - surgery; Female; Hemobilia - etiology; Hemobilia - surgery; Humans; Postoperative Complications - etiology; Postoperative Complications - surgery; Vascular Fistula - etiology; Vascular Fistula - surgery
• ISSN: 0930-2794

We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy (LC). This condition was due to the rupture of a pseudo-aneurysm of the right hepatic artery in the common bile duct, probably caused by a clip erroneously fired during LC on the lateral right wall of the vessel. It also caused the formation of multiple liver abscesses and the onset of sepsis. This life-threatening complication led to melena, fever, epigastric pain, pancreatitis, liver dysfunction, and severe anemia, requiring urgent hospitalization and operation. In the operating theater, the fistula was closed, the liver abscesses drained, and a Kehr tube inserted. Thereafter, the patient's general condition improved, and she is now well. LC is often considered to be the gold standard for the management of symptomatic cholelithiasis. However, recent data have undermined that opinion. The apparent advantages offered by LC in the short term (less pain, speedier recovery, shorter hospital stay, and lower costs) have been overwhelmed by the complications that occur during long-term follow-up. When the late downward trend in the bile duct and the vascular injury rate are taken into consideration, the learning curve is prolonged. Therefore, LC should be regarded as the surgical equivalent of a modern Peter Pan-i.e., it is like a young adult who should make definitive steps toward becoming an adult but does not succeed in doing so. We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy. Based on the facts in this case, we argue that the endoscopic procedure still needs to be perfected and cannot yet be considered the gold standard for selected cases of gallstone disease.