Multiple landmark identification and Clavien-Dindo classification system for complications after laparoscopic cholecystectomy

Background Since 1989 the World Health Consensus Conference established laparoscopic cholecystectomy as the standard operation for cholecystectomy. Laparoscopic cholecystectomy was associated with the significant rise in the rate of biliary complications compared with open surgery due to lack of experience and absence of standard anatomical landmarks and inefficient knowledge about the laparoscopic anatomy. The dependence on more than one landmark is suspected to be associated with the low rate of complications, and this is best monitored by the Clavien-Dindo grading system. Patients and methods Participants included 250 patients, who were admitted to the Department of Surgery at Al-Azhar University Hospital, Assiut branch. Laparoscopic cholecystectomy for variable etiologies such as gallstone disease was done depending on more than one landmark for cystic duct and cystic artery identification. Results Laparoscopic cholecystectomy was performed on 250 patients due to variable etiologies over a period of 13 months. Out of 250 patients, 145 (58%) were females and 105 (42%) were males. There were only three major complications that included postoperative hemorrhage, pulmonary embolism, and one bile leak. Conclusion Biliary complication is a preventable condition during laparoscopic cholecystectomy. Dependence on more than one landmark leads to avoidance of dissection and injury to important structures and hence leads to the absence of postoperative complications.