Early detection of complications after laparoscopic surgery: summary of a safety report from the National Patient Safety Agency

Abstract

Laparoscopic surgery is increasingly common—in 2005-6, 84% of the 49 077 cholecystectomies in England were undertaken laparoscopically.1 The technique is safe for most patients, and advantages include faster recovery and shorter hospital stay. A small number of people develop complications, however, some of which are specific to laparoscopy. These include gas emboli, arrhythmias, and shock when establishing the pneumoperitoneum (first step in any laparoscopic procedure). Injury to the bile duct and other organs is also more likely, given limited vision and control of the operative field compared with open surgery. Although most injuries are identified and dealt with during surgery, some are difficult to detect. One study of cases from US litigation claims showed that two thirds of laparoscopic injuries were initially missed.2 Some complications—such as diathermy damage to bowel, which results in late perforation or injury to the bile duct—may not present until several days after surgery.3 Late presentation of complications can cause problems because many laparoscopic procedures are done as day cases (sometimes in stand alone units). Signs can be subtle so may be missed by staff caring for patients after discharge in the community or on general wards. Delayed recognition of complications was the second most common reason for English litigation claims relating to laparoscopic cholecystectomy during the past 15 years.4 Between April 2005 and April 2010, healthcare staff in England and Wales reported to the National Patient Safety Agency (NSPA) 11 deaths and 37 serious incidents in patients who had deteriorated after laparoscopic surgery. These incidents are probably greatly under-reported, given what audit data show about complication rates.5 A typical incident reads: “The patient underwent laparoscopic cholecystectomy, deteriorated a day later. He was diagnosed with pancreatitis and …