Laparoscopic Cholecystectomy in a Patient With Ankylosing Spondylitis With Severe Spinal Deformity

Abstract

Laparoscopic cholecystectomy is the current gold standard for the management of cholelithiasis. As experience with laparoscopic cholecystectomy has increased, contraindications to the procedure have started decreasing. Kyphoscoliosis with fixed rigidity is considered as a relative contraindication to laparoscopic surgery. Ankylosing spondylitis is a challenge to the anaesthesiologist because it is associated with difficult intubation, restrictive ventilatory defects, and frequent cardiac involvement. The benefits of laparoscopic surgery can be extended to this group of patients with severe kyphoscoliosis due to advances in anesthesia and surgical expertise. We report a case of laparoscopic cholecystectomy performed in a patient with severe ankylosing spondylitis with fixed rigidity of the cervical spine and marked thoracolumbar kyphosis with severe restrictive lung disease. The purpose of this report is to describe the difficulties encountered in anesthesia and operative difficulties due to altered body habitus in terms of patient positioning and surgical access.

Laparoscopic resection of retroperitoneal paraganglioma behind the Spiegel lobe in a kyphotic patient: A rare case report

“…Previous reports have demonstrated the efficacy of the laparoscopic approach in managing colorectal and retroperitoneal cancer in kyphotic patients (1)(2)(3)(4)(5)(6)(7). It has been established that kyphosis limits multiport placement in tight external spaces when the patient is in the supine position.…”

Reduced port laparoscopic surgery for colon cancer in a patient with tuberculous kyphosis and dwarfism: a rare case and literature review.

“…The thoracic cage is often tilted anteriorly, resulting in low-lying costal margins and a narrow abdomen. A low-lying costal margin can divide the operative field [ 4 ]. Tajima et al .…”

Espondilite anquilosante e anestesia

“…A EA é uma contra-indicação relativa para a técnica cirúrgica videolaparoscópica. Em relato recente, são descritas as dificuldades encontradas pela equipe anestésico-cirúrgica em um paciente com acentuada cifoescoliose e rigidez, submetido à colecistectomia por videolaparoscopia 31 .…”

“…Ankylosing spondylitis is a relative contra-indication for videolaparoscopic surgery. A recent report described the difficulties that the anesthetic-surgical team faced in a patient with accentuated kyphoscoliosis and rigidity who underwent videolaparoscopic cholecystectomy 31 .…”