Anatomy relevant to cholecystectomy

Nagral, Sanjay

doi:10.4103/0972-9941.16527

Cited by 92 publications

(83 citation statements)

References 7 publications

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“…The most important patientrelated risk factors of operative bleeding are acute cholecystitis, liver cirrhosis, previous abdominal surgery, peritoneal adhesion and anatomical abnormalities [18][19][20]. Our data came in agreement with these results as we observed that operative bleeding was 7.84% in patients with acute cholecystitis, fibrotic gall bladder and extensive peritoneal adhesion.…”

Section: Discussionsupporting

confidence: 90%

Preoperative Prediction of the Difficulty of Laparoscopic Cholecystectomy

Saber¹

2015

J Surg Surgical Res

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Introduction: Preoperative complexity estimation helps deciding whether to proceed with a minimally invasive approach, perform an open procedure or make a referral to a more experienced surgeon. Laparoscopic cholecystectomy outcome is particularly affected by the presence and severity of inflammation, advancing age, male sex and greater BMI. Objective:The aim was to trace outcome of laparoscopic cholecystectomy with difficult situation. Patients and Methods:A total of 204 patients with difficult situation cholecystitis were enrolled to this study. The triad of clinical examination, laboratory data and ultrasound study was preformed for all patients. The primary end point of the study was operative outcome and the second end point was morbidity related to surgery. Results:The operative outcome was represented as operative bleeding and conversion to open surgery while the postoperative outcome was biliary leakage and port site infection. The total score for each patient with conversion to open surgery or with postoperative biliary leakage was between 6-10 points indicating difficult surgical approach according to the scoring system. Conclusion:Preoperative prediction of risk factors of conversion or difficulty is an important point for operative planning and the high risk patients may be informed accordingly. cholecystectomy in our patients with difficult situation according to the recently published scoring system [6].

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Section: Discussionsupporting

confidence: 90%

Preoperative Prediction of the Difficulty of Laparoscopic Cholecystectomy

Saber¹

2015

J Surg Surgical Res

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“…Anatomical landmarks in calot's triangle now could be easily identified paving the way to safe cholecystectomy. 11,12 If untreated, the wall echo complex is likely to form cholecystoduodenal fistula particularly if the calculi are present in the neck of gall bladder. This wall echo complex leads to inflammation, adhesion and erosion of duodenum.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic cholecystectomy in wall echo complex gall stone disease: a study

Arora

2017

Int Surg J

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Background: There are so many subtitles for difficult laproscopic cholecystectomy. Stone in the neck of gall bladder constitutes one of the entities. Wall echo complex is an ultrasound terminology used for cholelithiasis. It has three layers, first the pericholecystic fat between gallbladder and liver. Second layer consists of gall bladder wall. The third layer consists of echogenic stone itself. Wall echo complex is one of the entities which constitute difficult laproscopic cholecystectomy. Wall echo complex in the neck of the gall bladder is particularly difficult gall bladder where the conversion rates are high.Methods: The study was conducted in Department of Surgery. Standard four port cholecystectomy was done in 50 patients. Wall echo complex in all these patients was reported by ultrasonologist. Difficulties in operating wall echo complex cholelithiasis consisted of dissection of neck of gall bladder due to adhesions and a sleeve of fat covering the calot’s triangle. The difficulty of wall echo cholelithiasis was managed by opening the neck of gall bladder and evacuating the stones into a separate latex bag. By this procedure the difficult wall echo cholelithiasis was managed in all cases. Ligaclips were used for ligation of cystic duct, cystic artery and pericholecystic veins.Results: The evacuation of stones from the neck of gall bladder led to an easy cholecystectomy in 46 patients while the four patients had conversion to open cholecystectomy.Conclusions: Wall echo complex although an ultrasonologists entity but is a difficult gall bladder for laproscopic cholecystectomy.

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“…Jonson et al (6) stated that several reports have proposed that a cystic duct remnant >1 cm in length after cholecystectomy may be responsible, at least in part, for postcholecystectomy syndrome. Nagral (7) reported that anatomical facts are of relevance to the performance of a safe cholecystectomy. Misinterpretation of normal anatomy and anatomical variations contribute to the occurrence of major postoperative complications like biliary injuries following a cholecystectomy, the incidence being higher with laparoscopic cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

Role of MRCP in The Assessment of Patients Undergoing Cholecystectomy

Hussein

Salama²,

Elkader³

2018

The Egyptian Journal of Hospital Medicine

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Aim of the work: this study aimed to assess if the Magnetic Resonance Cholangiopancreatography (MRCP) in patients undergoing cholecystectomy, changed the treatment plan or changed the operation method. Patients and method: this study was carried out in the Radiology Departments of Ain Shams University Hospitals. A total of 30 patients undergoing cholecystectomy were referred for preoperative MRCP. They were 20 (66.7%) females and 10 (33.3%) males. Their age was ranged from 20-60 years old. Results: Among the 30 cases, 21 cases had dilated common bile duct (CBD), 11 patients had CBD stones, 2 of which were silent, one case had silent CHD stone, one case had Mirizzi type I syndrome, 3 cases had trifurcation of the CHD, 4 cases had cystic duct anatomic variants and one case had duplicated GB. Conclusion: In candidate patients for cholecystectomy, routine preoperative MRCP is mandatory for confirmation of the already known pathologies, detection of other missed pathologies by US as well as detection of anatomical variants of biliary tract, these will help the surgeon for replanning and adjusting the surgical approach to preventing or at least decreasing the probability of post operative complications.

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Anatomy relevant to cholecystectomy

Cited by 92 publications

References 7 publications

Preoperative Prediction of the Difficulty of Laparoscopic Cholecystectomy

Preoperative Prediction of the Difficulty of Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy in wall echo complex gall stone disease: a study

Role of MRCP in The Assessment of Patients Undergoing Cholecystectomy

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