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Surgical Case 1 Preoperative Diagnosis: Cholecystitis with cholelithiasis Postoperative Diagnosis: Cholecystitis with choleithiasis Procedure...

Surgical Case 1

Preoperative Diagnosis:

Cholecystitis with cholelithiasis

Postoperative Diagnosis:

Cholecystitis with choleithiasis

Procedure Performed:

Laparoscopic cholecystectomy with operative

cholangiogram

Anesthesia:

General

Bleeding:

None

Complications:

None

Description:

The patient was brought to the OR, placed in the supine

position, and given general anesthesia. The skin over the abdomen was

prepped with DuraPrep and draped in the sterile fashion. A 1-cm incision was

made above the umbilicus, and the Veress needle was introduced into

abdominal cavity obtaining pneumoperitoneum. A 10-mm trocar was

inserted and a laparoscope introduced. The patient had signiFcant

cholecystitis. Direct exploration of the abdomen was normal. Other trocars

were inserted into the subcostal space under direct vision. Lysis of adhesions

was performed. Exposure of the gallbladder bed was obtained, and the cystic

artery and the cystic duct were isolated. The common duct was of normal

size. The cystic duct was ligated distally and proximally and was opened. We

inserted the biliary catheter and obtained a cholangiogram that showed

anormal biliary tree. The catheter was removed and the cystic duct double

ligated with hemoclips and divided. The gallbladder was removed through

the upper trocar and dissected with electrocautery. The area was irrigated

with saline solution. The trocar was removed under vision and

pneumoperitoneum decompressed. The skin was closed with subcuticular

#4-0 Vicryl, and sterile dressing was applied. The patient tolerated the

procedure well.

Code(s): _______________________________________________________________

Index entries:

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