How is hemorrhage managed during laparoscopic cholecystectomy?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

When a large-vessel vascular injury occurs, it is usually at the time of initial abdominal access. Such injuries may be lethal complications. Development of a retroperitoneal hematoma or hypotension should be treated immediately by conversion to laparotomy.

Excessive bleeding in the region of the triangle of Calot should not be treated laparoscopically. In this situation, attempts at blind clipping or cauterization usually lead to worsening hemorrhage or hepatic artery injury. If, and only if, a bleeding site can be definitely identified and the locations of both the hepatic artery and the CBD are known, bleeding may be controlled with cauterization or clipping.

Bleeding in the gallbladder bed can usually be controlled by fulgurating the bleeding site. The authors prefer using a spatulated electrocautery wand for this purpose. If a larger intrahepatic sinus has been entered, hemostatic agents (eg, microfibrillar collagen) can be placed laparoscopically in the liver bed, and pressure can be maintained with a clamp. The argon plasma coagulator (APC) can be an excellent tool for severe gallbladder fossa oozing that is not responsive to simple electrocauterization.


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