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World J Gastrointest Surg. Mar 27, 2023; 15(3): 338-345
Published online Mar 27, 2023. doi: 10.4240/wjgs.v15.i3.338
Vascular injury during laparoscopic cholecystectomy: An often-overlooked complication
Antonio Pesce, Nicolò Fabbri, Carlo Vittorio Feo
Antonio Pesce, Nicolò Fabbri, Carlo Vittorio Feo, Department of Surgery, University of Ferrara, Azienda USL of Ferrara, Azienda USL of Ferrara, Lagosanto 44023, Ferrara, Italy
Author contributions: Pesce A designed the research; Pesce A and Fabbri N researched and wrote the manuscript; Feo C supervised the paper; all authors have read and approved the final manuscript.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Antonio Pesce, FACS, MD, PhD, Research Fellow, Surgeon, Department of Surgery, University of Ferrara, Azienda USL of Ferrara, Azienda USL of Ferrara, 2 Via Valle Oppio, Lagosanto 44023, Ferrara, Italy. antonio.pesce@ausl.fe.it
Received: November 27, 2022
Peer-review started: November 27, 2022
First decision: December 26, 2022
Revised: January 5, 2023
Accepted: February 22, 2023
Article in press: February 22, 2023
Published online: March 27, 2023
Processing time: 119 Days and 20 Hours
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; Vascular injury; Vascular anomalies; Surgical management; Specialized hepatobiliary centers

Core Tip: The theme of biliary injuries in laparoscopic cholecystectomy and the prevention and management of bile duct lesions have been extensively exanimated. However, little attention has been given to vascular injuries. Bleeding complications due to vascular injuries represent an important cause of morbidity and mortality, as well as the negative outcomes of biliary reconstruction when associated with biliary injuries. The vascular lesions should be correctly identified, and surgeons must choose the best therapeutic option to quickly repair the vascular lesion, depending on their own surgical experience and medical center resources. Currently, the management of referrals to specialized hepatobiliary centers for multidisciplinary approaches is mandatory.