Revista Científica Interdisciplinaria Investigación y Saberes
2024, Vol. 14, No. 2 e-ISSN: 1390-8146
Published by: Universidad Técnica Luis Vargas Torres
How to cite this article (APA):
Quizhpi, D., et. al (2024) Analysis of situations and post-
surgical complications in cholecystectomy: an Ecuadorian society approach, Revista
Científica Interdisciplinaria Investigación y Saberes, 14(2) 99-118
Analysis of situations and post-surgical complications in
cholecystectomy: an Ecuadorian society approach
Nivel de incertidumbre de los cuidadores frente al paciente pediátrico hospitalizado
Deicy Dolores Quizhpi Palchizaca
Licenciada en enfermería, Magister en Gestión del Cuidado, Universidad Católica de Cuenca, docente
deicy.quizhpi@ucacue.edu.ec, https://orcid.org/0000-0003-1936-7307
Luis Enrique Naula Chucay
Licenciado en enfermería, Magister en Enfermería mención en Cuidados Críticos Universidad Católica de
Cuenca, docente, luis.naula@ucacue.edu.ec https://orcid.org/0009-0007-4519-5939
Nancy Karina Sumba Juela
Dra. Universidad Católica de Cuenca, estudiante
nksumbaj85@est.ucacue.edu.ec, https://orcid.org/0009-0009-2297-7836
Erika Gissela Guaman Chimbay
Dra. Universidad Católica de Cuenca, Estudiante,
erika.guaman.05@est.ucacue.edu.ec, https://orcid.org/0009-0001-7120-1906
Cholecystectomy is a surgical intervention performed with the aim of
removing the gallbladder, using different laparoscopic techniques,
the intervention is performed with the application of a video camera
and special materials without the need to open the patient's
abdomen. To carry out a bibliographic review of the scientific
literature on post-surgical complications in cholecystectomy in
Ecuador. A documentary study of literature review was carried out
using a qualitative approach, with a descriptive design through the
analysis and compilation of relevant information from scientific and
academic sources. For the search for information, we worked with the
databases Scopus, Pubmed, Web of Science and the library of the
Catholic University of Cuenca. Post-surgical complications of
cholecystectomy are related to sociodemographic factors, i.e. intrinsic
Abstract
Received 2024-01-05
Revised 2024-03-11
Published 2024-05-01
Corresponding Author
Deicy Dolores Quizhpi Palchizaca
deicy.quizhpi@ucacue.edu.ec
Pages: 99-118
https://creativecommons.org/lice
nses/by-nc-sa/4.0/
Distributed under
Copyright: © The Author(s)
Analysis of situations and post-surgical complications in cholecystectomy: an Ecuadorian
society approach
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factors such as age, sex, comorbidities and others, and extrinsic
factors related to the surgical process. The most frequent post-
surgical complications in laparoscopic cholecystectomy are: nausea,
vomiting, wound infection, jaundice preceded by pancreatitis,
choledocholithiasis, while in open cholecystectomy they are: nausea
and vomiting, lower abdominal pain, gastritis, jaundice, diarrhoea,
irritable bowel syndrome.
Key words:
Risk factors, postoperative complications,
cholecystectomy, patient care
Resumen
La colecistectomía es una intervención quirúrgica que se realiza con
el objetivo de extirpar la vesícula biliar, para ello se utilizan diferentes
técnicas laparoscópicas, la intervención se la realiza con la aplicación
de una cámara de vídeo y materiales especiales sin tener la necesidad
de abrir el abdomen del paciente. Efectuar una revisión bibliográfica
de literatura científica sobre las complicaciones postquirurgicas en
colecistectomía en el Ecuador. Se realizó un estudio documental de
revisión bibliográfica, misma que abordó un enfoque cualitativo, con
un diseño descriptivo por medio del análisis y la recopilación de
información relevante proveniente de fuentes científicas y
académicas. Para la búsqueda de información, se trabajó con las
bases de datos Scopus, Pubmed, Web of Science y la biblioteca de la
Universidad Católica de Cuenca. Las complicaciones postquirúrgicas
de la colecistectomía se relacionan con los factores
sociodemográficos, es decir por factores intrínsecos como la edad,
sexo, las comorbilidades y demás, y los factores extrínsecos
relacionados al proceso quirúrgico. Las complicaciones
postquirúrgicas más frecuentes en colecistectomía laparoscópica son;
Nauseas, Vómito, Infección de herida, Ictericia precedida de
pancreatitis, Coledocolitiasis, mientras que en colecistectomía abierta
son: náuseas y vómitos, dolor abdominal inferior, gastritis, ictericia,
diarrea, síndrome de intestino irritable.
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Palabras clave:
Factores de riesgo, complicaciones postquirúrgicas,
colecistectomía, cuidado del paciente.
Introduction
Cholecystectomy is a surgical intervention performed on the
complications present in the gallbladder, despite the progress and
technological innovation that has been developed year after year in
favour of science and medicine; there are several cases of
complications derived from said medical procedure, thus causing the
need for priority attention. (Giraldo Molina, 2017) In addition, a
number of situations have become evident that compromise the
patient's health due to complications derived from cholecystectomy,
those are associated with surgical lesions of the biliary tract, and may
present infections in the wound, evidencing the suffering of
choledocholithiasis, biloma, coleperitoneum, injury to major and
minor vessels.
In this context, Alvarez and Vargas, in their study carried out in Spain,
analysed the frequency of morbidity caused by postoperative
complications in conventional cholecystectomy, and found the
following: 4% to 12% together could show post-surgical haemorrhage
and peritonitis (Alvarez Vargas, 2018).
While Perez (Perez Benitez , Post-operative complications in patients
with conventional cholecystectomy and its impact on postoperative
hospital stay in Hospital de la Amistad Peru Korea II - 2 Santa Rosa in
Piura, 2017), in the city of Piura, in his study conducted taking as a
sample 105 patients of the hospital of friendship of Peru Korea II2
Santa Rosa, showed that the average age at which postoperative
complications predominated was 35 and 46 years, where the female
gender predominated, resulting in this being an associated factor in
complications of laparoscopic cholecystectomy together with the
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diseases suffered by the patients or comorbidities and abdominal
surgeries.
From this perspective, the study conducted by Barzola and Macias
regarding nursing interventions in cholecystectomy-mediated
postoperative complications at the General Hospital Dr. Liborio
Panchana Sotomana Sotomán. Liborio Panchana Sotomayor, in
Salinas Ecuador, (Barzola Suárez & Macías Panchana, 2018)
determined that complications derived on a sample of 53 patients
who underwent cholecystectomy: 50% presented pain, 17% vomiting,
17% loss of body temperature, 16% yellow skin and 13% changes in
blood pressure.
In addition, it is important to point out that the complications
mentioned may vary according to the patient's waiting time and the
conditions in which the hospital unit is located, as it is certainly in this
place where there is a greater probability of infection and, as a result,
complications, 2020) showed in his study carried out at the Enrique
Garcés hospital in Quito, Ecuador, that the length of stay in the
hospital centre taken as the object of the study varied: 71% of patients
were hospitalised for 3 days for immediate cholecystectomy, 45%
stayed 4 days for early cholecystectomy and lastly, 53% of patients
were hospitalised for late cholecystectomy for 7 to 10 days.
In the opinion of Aguirre and Adriana, in their thesis carried out at the
University of Guayaquil, they carried out an investigation at the
University Hospital, with the aim of revealing the rate of postoperative
complications in cholecystectomy, 23% of the patients presented
postoperative complications of conventional or laparoscopic
cholecystectomy of the total population that was the object of the
study, likewise, it was identified that the most frequent associated
factor in these complications is gender, followed by age and medical
history (Maurath Aguirre, 2019).
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Therefore, the development of this research is justified due to the
high incidence and prevalence of post-surgical complications, which
drives the need to address this issue, as it is necessary to demonstrate
the methods by which doctors perform the practice of such surgery,
emphasising that there are invasive, simple and practical methods for
performing cholecystectomy, and despite this: in our country, open
cholecystectomy is still considered to be the most viable, due to
various factors: lack of training of doctors in laparoscopic training, lack
of the necessary medical technology equipment, lack of personnel,
etc.
At the same time, a significant social relevance is covered, as the
study focuses on the analysis of the most relevant information
approached from the perspective of different authors, where the most
significant results show the causes and consequences of post-surgical
complications, benefiting the population that requires it, and of
course the general public as it shows the importance of strict post-
operative care, methods of prevention of complications and proper
patient care. In this sense, the aim of this article is to carry out a
bibliographic review of the scientific literature on postoperative
complications in cholecystectomy in Ecuador.
Post-surgical complications are medical disorders that occur
infrequently after interventions; however, the highest incidence is
certainly related to several factors, whether clinical, social,
demographic, etc. Thus, Martos Benítez et al. (Martos Benítez, 2017)
allude that postoperative complications are difficulties that should be
taken into consideration as a priority in patient care and risk
prevention policies in hospital centres, with patient health and
stability as a priority, and, in the case of requiring the implementation
of structural changes to mitigate postoperative morbidity and
mortality, to implement them urgently.
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Post-surgical complications of cholecystectomy are related to clinical
sociodemographic factors of each patient, i.e. intrinsic factors such as
age, sex, comorbidities and extrinsic factors which are those related
to the surgical process (Bellido Huertas J. 2017).
Gender. With regard to male or female sex, it cannot be inferred that
one of them is the main one in relation to post-surgical complications
in cholecystectomy, so there is no explanatory association between a
certain gender and the complications that derive from it. (Aguilar
Bazurto, 2017).
However, the female sex is more prone to suffer from biliary
pathologies such as lithiasis, which results in a higher frequency of the
female gender in cholecystectomy, and consequently, this will be
more common in the rate of postoperative complications of
cholecystectomy, so Brañez, (Brañez Baltazar, 2019) alludes that
according to this fact it is usually deduced that the female gender is a
factor that is associated with being more likely to have complications
in cholecystectomy. However, the male gender also tends to
predominate in this type of surgery and these complications, which
varies the frequency of complications by gender. (Perez Benitez, Post-
operative complications in patients with conventional
cholecystectomy and its impact on postoperative hospital stay in the
hospital of friendship Peru Korea II-2 Sta Rosa, 2017).
Age. According to Racines Narváez et al. (Racines Narváez & Reyes
Moscoso, 2019) a risk factor identified in postoperative complications
in cholecystectomy is advanced age, precisely in adults over 65 years
of age, who develop greater difficulty in their postoperative recovery
and, in turn, is accompanied by other associated pathological
diseases that probably tend to increase the risk of mortality and
complications in cholecystectomy.
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Comorbidities and pathological history. Comorbidities are the
patient's own diseases, such as obesity, diabetes mellitus, cancer,
liver cirrhosis, chronic renal failure (CKD), which, although some of
these pathologies do not have such a detrimental effect, can affect
the length of stay in the hospital and affect the postoperative course;
these comorbidities become a factor in postoperative complications.
According to Fauci et al. (Fauci, et al., 2017) Diabetes Mellitus is a
factor that interferes with the wound healing processes of
cholecystectomy surgery, as well as Hypertension is another clinical
factor associated with complications, as it increases anaesthetic risk
and contributes to bleeding.
Surgical complexity. Surgical complexity is related to postoperative
complications, whether for laparoscopic or open cholecystectomy
surgery, since any error by the medical team can have negative effects
on the patient's recovery. (Collantes Goicochea, 2018).
Clinical factors. In the same way, and as previously stated about socio-
demographic factors, Bellido, (Bellido Huertas J. M., 2018) briefly
explains the clinical factors that are associated with post-surgical
complications in cholecystectomy: type of surgery, fever, jaundice,
choluria, ASA.
Lifestyle. The patient tends to present post-surgical complications if
he/she maintains a fast-paced and careless lifestyle, including
activities that involve lifting heavy items, neglect of nutritious food
intake, frequent consumption of fatty foods, and the use of harmful
substances, alcohol, tobacco, drugs (Permanent Medicine, 2020).
Cultural factors influencing patients in the management of post-
surgical complications
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According to Garcia, (Garcia, 2019) traditional medicine has become
very common worldwide among different social groups, as it
maintains an effectiveness to heal various diseases from simple colds
to much more complex ailments, such as epilepsy, Parkinson's,
among others; therefore, countless people opt for this type of
medicine, because health experts have begun to value its benefits.
Then, because of the effectiveness that natural medicine has proven
to have in efficiently alleviating discomforts such as pain and nausea,
which are frequent in the post-surgical complications of
cholecystectomy, many patients choose to resort to this type of
medicinal alternative, due to the customs or beliefs held by various
rural groups. (Nazar, Bastidas, Fuentes, Zamora, & Coloma, 2017).
Most frequent postoperative complications in laparoscopic and open
cholecystectomy in Ecuador.
According to Lascano Gallegos et al. (Lascano Gallegos, Comas
Roríguez, & Murriagui Barrera, 2018), the most frequent post-surgical
complications in laparoscopic cholecystectomy identified in hospitals
and health centres in Ecuador are nausea, vomiting, surgical wound
infection, jaundice preceded by pancreatitis, and choledocholithiasis.
A patient who has undergone a laparoscopic operation has various
complications ranging from mild to severe, Domínguez (Domínguez
Membreño, 2017) that may even require a liver transplant due to the
possible complications arising from such an intervention.
The symptoms after cholecystectomy surgery or postoperative
complications of open cholecystectomy will depend to some extent
on the case of each patient, however, according to Salazar et al.
(Salazar Morales & Romero Santana, 2019) the most frequent
postoperative complications observed in hospitals in Ecuador are
nausea and vomiting, lower abdominal pain, gastritis, jaundice,
diarrhoea, irritable bowel syndrome, gastrointestinal reflux disease,
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gastroesophageal reflux disease, gastrointestinal reflux disease and
gastrointestinal reflux disease. Gastroesophageal reflux disease. In
addition to the above, Encalada et al. (Encalada Calero, Jaramillo
Martínez, Ramírez García, & López Chinga, 2017) mention that it is
also possible to generate conditions that require further surgery
leading to cirrhosis or, in the worst case, death.
Cholecystectomy is one of the most common surgical procedures in
the general population, being used to solve diseases of the biliary
tract, which is currently a problem of great morbidity worldwide, and
is one of the most frequent reasons why people go to the emergency
section of a hospital centre. According to Gonzaga, (Gonzaga Peña,
2017) the prevalence of cholecystectomy at a global level in adults
varies between 5.9% and 21.9%, with variability by geographical and
regional locations; on the other hand, the mortality rate is
accentuated in older people. In Ecuador, at least 75% of gallstones
are caused by cholesterol.
The epidemiological characteristics of the disease are that it is more
prevalent in women than in men. The frequency of the disease
increases with age, the older the age, the higher the risk of
gallbladder and biliary diseases. Obese people have an increased risk
of gallbladder disease, as being overweight increases biliary
cholesterol secretion. The authors Ulloa and Vega reveal that the most
frequent age of patients who come to the centre with this disease is
between 40 and 60 years old, prior to which a diagnosis is made to
determine whether the degree is mild or malignant (Ulloa & Henry,
2019).
In summary, the epidemiological factors that can generate the
development of gallbladder disease and post-surgical complications
after cholecystectomy are basically age, sex, Body Mass Index (BMI)
and additional comorbidities (Quiroga Meriño, Estrada Brizuela,
Hernández Agüero, Fuentes Ferrales, & Consuegra Román, 2020).
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Nursing care in patients with complications following
cholecystectomy surgery
The nursing care provided to patients with post-surgical
complications in cholecystectomy is based on the aim of repairing
possible damage generated after surgery, whether due to poor
hygiene, inadequate nutrition, etc. (Mastache Martinez, 2018).
Surgical wound care will be one of the recommendations to be
emphasised, as surgical site infection (SSI) is currently one of the most
frequent causes of complications in the post-operative period and
accounts for 38% of all infections associated with health care (Ximena
Torres, 2022). (Ximena Torres, 2022)
The care provided is: Monitoring of vital signs. Administer pain and
infection control medication as prescribed by the physician. Healing
and cleaning of the surgical wound. Monitoring for possible wound
drainage. Signs of infection, onset of fever or hyperthermia, swollen
edges, oozing or foul odour. Control of water and electrolyte balance
(Rodriguez Velasco, 2018).
Including assessment of gastrointestinal function, through
auscultation of hydro-aerial bowel sounds. Urinary elimination to
check renal function. Soft diet. Explain to the patient that moderate
physical activity should be carried out progressively, such as starting
with gentle steps for short distances without great intensity and
gradually returning to the activity they had before. (GUTIERREZ,
2022).
Methodology
A documentary study of bibliographic review was carried out, using a
qualitative approach, with a descriptive design through the analysis
and compilation of relevant information from scientific and academic
sources. For the search of information, we worked with the databases
Analysis of situations and post-surgical complications in cholecystectomy: an Ecuadorian
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Scopus, Pubmed, Web of Science and the library of the Catholic
University of Cuenca. Together with the combination of keywords and
Boolean operators AND, OR and the use of Descriptors in Health
Sciences DeCS.
Studies were selected that were related to post-surgical complications
in cholecystectomy in Ecuador, with respect to the inclusion criteria,
articles in English and Spanish published within the last 5 years were
chosen. Studies that were not related to the research, publications
less than 5 years old and that did not belong to the English and
Spanish language were excluded.
With regard to the above, it should be emphasised that with the
application of the descriptive-argumentative methodology, priority
was given to locating secondary sources with the most outstanding
findings on the theory and statistical data addressed by different
authors, arguing the most relevant information, perfecting the
research through the appropriate analysis of the information
presented, allowing the socio-demographic factors of post-surgical
complications in cholecystectomy to be shown, adding support for
their own opinions, based on the idea of the authors.
Results
The epidemiological characteristics of cholecystectomy are varied, as
with respect to clinical socio-demographic factors and lifestyle
associated with post-surgical complications in cholecystectomy, it is
highlighted that the prevalence and frequency of gallstone disease
increases with age, lifestyle, and even gender. The most relevant
results show that people with a high rate of obesity predispose to a
higher risk of gallbladder disease, as shown in the study conducted
by Navas et al. (Navas Montero, Martínez Martínez, & Palomino
Hurtado, 2016) in 2022 regarding the relationship between
overweight and obesity and the evolution of patients undergoing
cholecystectomy surgery at the Hospital Sagrado Corazón de Jesús
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Quevedo concluded that: out of a sample of 33 patients admitted to
the hospital for gallbladder disease, they were diagnosed with grade
I obesity and overweight; however, post-surgical complications were
minimal.
Similar information is reported by Lasnibat et al. (Lasnibat R, et al.,
2017) in their study on cholelithiasis in obese patients undergoing
bariatric surgery: 12-month postoperative study and follow-up, it is
evident that several patients (52.8%) who have suffered from obesity
and therefore underwent bypass surgery, potentially increase the risk
of forming solid residues in the gallbladder called cholelithiasis, and
within 12 months the need for cholecystectomy intervention arises.
It should also be noted that age is a determining socio-demographic
factor for the occurrence of post-surgical complications in
cholecystectomy, since the older the individual is, the greater the
probability of being operated on for this type of operation, or for
complications that arise after the surgical process. Diaz et al. (Diaz
Calderin, Fuentes Valdes, Vilorio Haza, Silvera Garcia, & Perez
Gonzalez, 2018) in their study determined that of 3,900 patients over
70 years of age who underwent laparoscopic cholecystectomy, 83.9%
of them were between 70 and 79 years of age, so the older the
patient, the greater the risk of being operated on by cholecystectomy,
based on the opinions of various authors, laparoscopic surgery is the
safest for this group of patients.
When a cholecystectomy is performed, there is a high probability of
suffering various complications that are associated with intrinsic and
extrinsic factors. Intrinsic factors include age, comorbidities and
gender; the latter continues to be the subject of debate in many
investigations since, on the one hand, it is evident that the female
gender has a higher probability of suffering from lithiasis and
therefore the development of complications from cholecystectomy,
however, it is also determined that the male gender is prone to
undergo these surgeries. A clear example of this is provided by
Morales et al. (Zambrano Morales, Ponce Moreno, & Casanova
Castillo, 2018) in a sample of 23 patients who underwent
cholecystectomy, 78.26% were female and 21.74% were male.
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With regard to extrinsic factors, these are complexities originating in
the operating theatre, clinical pictures of the patient such as
symptoms of fever, choluria and jaundice and, finally, lifestyle is one
of the most important factors related to the complications of this
medical intervention, as it was identified that as long as patients have
a healthy lifestyle both in terms of diet and physical activity, the level
of risk will decrease.
According to national studies, in hospitals in Ecuador, the frequent
complications that occur after laparoscopic cholecystectomy are:
nausea, vomiting, incisional and bile infections. In addition, Chama et
al. (Chama Naranjo, Farell R, & Cuevas O, 2021), in their study carried
out to demonstrate safe cholecystectomy, state that another frequent
complication is gallbladder lesions, with an incidence of 0.2% to 0.4%.
Similarly, open cholecystectomy is associated with abdominal pain at
the incision site, gastritis, jaundice, irritable bowel and gastric reflux.
Currently, cholecystectomy surgery is one of the most common
procedures in health systems. In Ecuador, the reality is the same as in
other countries, as it is the most common procedure used to treat
pathologies such as cholelithiasis and cholecystitis, which are the
diseases that are most frequently seen in health care centres, As has
been determined, there are two characteristic interventions of this
operation, which is laparoscopic and open surgery, both types of
procedures generate postoperative complications if the patient has a
medical history that slightly or moderately compromises the recovery
process.
According to the results, the importance of the laparoscopic
cholecystectomy procedure is highlighted, as the results of several
authors show that this procedure is safer, generates fewer
complications, and has a faster recovery process, as well as being less
invasive for the patient. It is important to highlight that each
procedure has its advantages and disadvantages, always depending
on the patient's medical history, and the different factors that
intervene before, during and after surgery.
In the study by Zambrano et al. regarding the experience in
laparoscopic cholecystectomy at the Hospital Dr. Verdi Cevallos
Balda, the patient's medical history and the different factors that
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intervene before, during and after the surgery. Verdi Cevallos Balda
Hospital, Ecuador, it is stated that cholecystectomy complications will
vary according to the type of operation performed. In our country, the
most recurrent cholecystectomy surgery is laparoscopic
cholecystectomy, as evidenced in the results of the research where
several authors affirm this according to the data obtained in their
studies, as the process represents a rate of 5.6% of postoperative
complications and also the hospitalisation of the patient is one or two
days, which is consistent with the research of Buri et al. (Buri Parra ,
Ulloa Gómez, Vega Cuadrado, & Encalada Torres, 2018) as the
average patient stay surrounds 2 days and also complications are
minimal, in 94.4% of clinical cases they did not indicate complications.
Several studies show that the female gender tends to suffer greater
complications from cholecystectomy, with respect to the male
gender, and in this section the hypothesis is reaffirmed, as one of the
most relevant results details the following, In the Military Hospital of
Cuenca, Ecuador during the time of research on 822 patients treated
for cholecystectomy between January 1996 to December 2015, (Buri
Parra, Ulloa Gómez, Vega Cuadrado, & Encalada Torres, 2018) shows
that the female gender prevailed with 61.8% over the male gender,
emphasising that those patients aged between 40 and 60 years
remained in hospital for an even longer period of time.
Conclusions
Among the main postoperative complications of laparoscopic
cholecystectomies, haemorrhages are the most common, followed by
nausea and vomiting, and in third place jaundice and omoalgia: the
female gender predominates in the suffering of postoperative
complications, while, with respect to age, adults and older adults have
a higher frequency of suffering from them.
In Ecuador, laparoscopic cholecystectomy, despite being the most
recommended, is undoubtedly a major challenge for medical
personnel, due to the lack of knowledge and training, as well as the
scarce material and technological resources in the public health
system, which complement the necessary requirements for success
and the reduction of postoperative risks.
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In general, the main risk factors for the development of postoperative
complications are: the type of surgery, the patient's age, the patient's
nutritional status, and the patient's comorbidities, all of which form an
equation that leads to the generation of complications associated
with cholecystectomy surgical procedures. In addition to the above,
it should be noted that the laparoscopic cholecystectomy procedure
is much more common in adults because, in most patients, the results
are effective and have a low rate of complications, in addition to the
fact that the technique is less invasive.
The various complications that can arise from the different
procedures, it is extremely important that the medical and nursing
staff are highly trained to prevent unfavourable situations and
maintain adequate care for patients in all the guidelines required,
control of signs, healing, administration of medicines, and the
preparation of clinical histories for the analysis and study of the
comorbidities of each patient.
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