Technique of Laparoscipic Placement of Hyaluronate-Carboxymethylcellulose in Patients Following Laparoscopic Cholecystectomy

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  • 腹腔鏡下胆嚢摘出術における肝床部への術後腸管癒着防止フィルム貼付手技の工夫
  • フククウキョウカ タンノウ テキシュツジュツ ニオケル カンショウブ エノ ジュツゴ チョウカン ユチャク ボウシ フィルム チョウフ シュギ ノ クフウ

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We sometimes encounter cases requiring a laparoscopic gastrectomy along with postlaparoscopic cholecystectomy. In these cases, we need to perform an unusual and difficult procedure for adhesion of the bulbus and the hepatoduodenal ligament. SeprafilmTM is known to reduce the incidence and the extent of peritoneal adhesion. However, it is difficult to place SeprafilmTM via laparoscopic surgery. We report a new technique for placement of SeprafilmTM under the laparoscopic cholecystectomy. Laparoscopic placement of SeprafilmTM is carried out in 6 steps as follows: (1) preparation for inserting the delivery tube using an Endopouch RetriverTM, (2) division of SeprafilmTM into 3cm×6cm pieces along with its covering paper, (3) rolling of each piece and tying it with a rubber band, (4) inserting the rolled SeprafilmTM into the delivery tube, (5) pushing the rolled piece with a 10mm Cherry DissectorTM, and (6) under laparoscopic view, directing the delivery tube to the desired location and pushing out the piece with the Cherry DissectorTM. The pushed piece spreads automatically. In this method, there is no need to grasp the SeprafilmTM, and it can be easily placed while keeping it dry.

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