New strategies of laparoscopic cholecystectomy from left upper abdomen under massive adhesion of right upper abdomen
10.3969/j.issn.1007-1989.2016.02.024
- VernacularTitle:右上腹瘢痕粘连下左上腹两新入路腹腔镜胆囊切除术的改进策略
- Author:
Shunxin YAN
;
Zhaowen ZHONG
;
Yan SUN
- Keywords:
massive adhesion in right upper abdomen;
two new roads from left upper abdomen;
laparoscopic cholecystectomy;
instrument channel;
operating space;
strategy
- From:
China Journal of Endoscopy
2016;22(2):99-103
- CountryChina
- Language:Chinese
-
Abstract:
Objective Seen from the laparoscope, there is massive adhesion after the peritonitis, an operation with a large incision or radiation treatment in right upper abdomen. After failing to dissociate the adhesion and create e-nough space with the help of laparoscope, the laparoscopic cholecystectomy from the left upper abdomen is adopted depending on the specific situation to explore the possibility and practicability of creating instrument channel and operating space. Methods From May 2001 to May 2015, 13 patients (with a medical history of peritonitis, an opera-tion with a large incision, serious peritonitis or radiation treatment in right upper abdomen) were received operations of laparoscopic cholecystectomy, adhesion was serious near the trauma or otherwise. During the operation, massive adhesion was found in the right upper abdomen. The conventional LC did not work. Instrument channel and operat-ing space were created from the left upper abdomen through facies inferior hepatis and falciform ligament. LC cost 70 minutes to 155 minutes with an average of 117 minutes. Results LC of 13 patients (with a massive adhesion) from left upper abdomen was successful. In this way, it was easy to create instrument channel and operating space and avoid the massive adhesion. The operations took a longer time without injuring stomach intestines and bile vessel. Conclusion Acquired adhesion's peculiarity is negative correlation with distance, LC from the left upper abdomen through facies inferior hepatis and falciform ligament can be avoided the disassociation of massive adhesion and be created the instrument channel and operating space. The two ways are proved to be effective.
