Complicated cholecystectomy-safe dissection technique скачать в хорошем качестве

Complicated cholecystectomy-safe dissection technique

22 yr lady came with acute calculus cholecystitis not relieved by injectables. During laparoscopy , GB was found hugely distended, elongated, thick walled and there was adhesions ofomentum, Duodenum and stomach on the body and neck. After adhseolysis it was not possible to identify the cystic duct separately from adjacent structures. Lymph node was identified and the vessel distal to it on the GB body was cauterized, divided and dissected medially. There was a stone stuck into a part not clearly separable from adjacent and underlying structures which could be part of bile ducts. So the GB was freed by dissection from fundic side, as much medially as possible without damaging any unidentified structure. Then GB was partially divided above this stone containing part, enlarged the opening and stone dislodged. No further dissection was attempted medially. The big opening was closed using continuous suture with vicryl. The remaining attachment of GB was ligated and divided and the GB and the stone were put into condom bag. Peritoneal cleansing was done. A drain was kept and the bag retrieved.