Three Cases of Cholelithiasis with Previous Abdominal Surgery Performed Single Incision Laparoscopic Cholecystectomy

SHIMIZU Yoshimasa, SUZUKI Kazumitsu, SEKI Takatoshi, OZAWA Yosuke, TACHIKAWA Nobuo, SHATARI Tomoo

doi:10.3919/jjsa.79.1758

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Other Title

単孔式腹腔鏡下胆嚢摘出術を施行した手術既往のある胆嚢結石の3例
症例単孔式腹腔鏡下胆囊摘出術を施行した手術既往のある胆囊結石の3例
ショウレイタンコウシキフククウキョウカタンノウテキシュツジュツオシコウシタシュジュツキオウノアルタンノウケッセキノ 3レイ

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Abstract

We have performed single incision laparoscopic cholecystectomy for three cases of cholelithiasis with previous histories of abdominal surgeries. Their previous surgeries included gastrectomy under laparotomy, Cesarean section and appendectomy in Case 1 ; laparoscopic ileocecal resection for Crohn disease and laparoscopic dissection of adhesions with partial enterectomy for ileus in Case 2 ; and gastrectomy under laparotomy in Case 3. Extensive adhesions were confirmed in the periumbilical area and the upper abdomen in Case 1 and 2. We performed dissection of the periumbilical adhesions under direct vision and placement of a multichannel port, followed by laparoscopic dissection of adhesions in the upper abdomen and around the gallbladder to remove the gallbladder. In Case 3, intraoperative injury of the cystic artery caused hemorrhage, for which rapid taking out and putting in of gauzes through the periumbilical port enabled us to see the bleeding point directly, leading to successful hemostasis.<BR>Compared to the conventional or needlescopic cholecystectomy, the single incision laparoscopic cholecystectomy demands a high degree of technical difficulty. However, we consider the method to be excellent, because it can dissect periumbilical adhesions under direct vision and it can reach at the gallbladder in the minimal dissecting areas. And if emergency complications such as bleeding may occur, easy taking out and putting off gauzes as well as hemostatic agent can be done by getting on and off the port, showing a superiority even in emergency situations.

Journal

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 79 (8), 1758-1763, 2018

Japan Surgical Association

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