У нас вы можете посмотреть бесплатно Laparoscopic cholecystectomy for chronic calcular cholecystitis with cholecystocolic fistula (part1) или скачать в максимальном доступном качестве, видео которое было загружено на ютуб. Для загрузки выберите вариант из формы ниже:
Если кнопки скачивания не
загрузились
НАЖМИТЕ ЗДЕСЬ или обновите страницу
Если возникают проблемы со скачиванием видео, пожалуйста напишите в поддержку по адресу внизу
страницы.
Спасибо за использование сервиса ClipSaver.ru
إستئصال المرارة بالمنظار الجراحي مع غلق ناسور بين المرارة والقولون المستعرض ناتج عن إلتهابات وحصوات المرارة والشافي هو الله والحمد لله رب العالمين. Laparoscopic cholecytectomy for chronic calcular cholecystitis with Cholecysto-colic fistula : case report and Laparoscopic management. A 49 y old female obese patient presented with a history of Chronic calcular cholecystitis with recurrent acute attacks of about 5 years duration, during the acute attacks there is fever and rigors, abdominal pain mainly in the right hypochondium, sometimes there is associated diarrhoea. During the acute attacks the patient usually receives antibiotics, antipyretics for few days until improvement. during the last 6 months the attacks were more frequent.The Patient presented to us for laparoscopic cholecystectomy. Abdominal examination revealed tenderness in the right hypochondium. The Patient received antibiotic and analgesics. Ultrasonography showed contracted gallbladder on strong echo with a diagnosis of chronic calcular cholecystitis. Laboratory investigations after antibiotic and analgesic treatment were unremarkable. The Patient prepared for Laparoscopic cholecystectomy. During laparoscopy, at first we couldn't see the gallbladder from the extensive adhesions around it from the fat and the proximal transverse colon, lysis of tough adhesions to the fat of the colon was done meticulously starting from the fundus to the body of the gallbladder until we found that there is suspicion of cholecystocolic fistula with absence of demarcation between the wall of the contracted gallbladder and the wall of the colon at the site of the fistula and it was impossible to dissect between the wall of the gallbladder and the colon at the site of the fistula, we started to be cautious during dissection to avoid iatrogenic colonic injury but we tried to dissect all around the fistula to make it as narrow as possible, then we applied clips on the fistulous tract near the gallbladder preserving the colonic wall and then we divided the fistulous tract on the wall of the gallbladder leaving a cuff of the wall of the gallbladder so as to avoid slipping of the clips ; also we applied clips on the gallbladder cuff to allow easy identification of the site of the fistula radiologically or Laparoscopically . The opened gallbladder was aspirated and cleaned from stones, then Laparoscopic cholecystectomy was completed in a normal fashion. And abdominal drain was inserted . The Key messages are : The preoperative diagnosis of cholecystocolic fistula is difficult, and Ultrasonography is usually not valuable. If , there is suspicion of fistula, CT scan may be of value. During Laparoscopic cholecystectomy for chronic calcular cholecystitis with contracted gallbladder over stones, we have to be careful during dissection of the gallbladder from adhesions to the colon, and if there is extensive tough adhesions to the wall of the colon with loss of demarcation between the wall the gallbladder and the adherent wall of colon we have to suspect cholecystocolic fistula. The Laparoscopic management of cholecystocolic fistula is feasible and it depends on the size and site of the fistula; clipping of the fistula tract near the gallbladder wall, leaving a small cuff of the gallbladder wall attached to the fistula so as to avoid slipping of the clips and protecting the colon is an option; if the fistula tract has been disconnected before clipping or if it is wide, suturing of the colon at the site of the fistula is needed after trimming of the edges, another easy but more expensive option is to use Endoscopic linear Stapler if available to secure and divide the fistula tract. والشافي هو الله والحمد لله رب العالمين.