Laparoscopic Cholecystectom Hamed Rashad Gall Bladder The gall
Laparoscopic Cholecystectom Hamed Rashad
Gall Bladder The gall bladder is the organ in the body responsible fore concentrating and storing bile
Relations of GB to surroundings
Usually G stones look like this
Two large gall stones : Notice how they reflect back shadows
Thick sludge in the gall bladder
Gall stones seen in ordinary x-ray
Laparoscopic Cholecystectomy(LC) Indication: Symptomatic gallstones l Other biliary tract disease l Difficult technical challenges Acute cholecystitis l Obesity l Previous intra-abdominal surgery l Pregnancy l
Benefit of LC Shorter hospital stays More rapid return to normal activities Small, limited incisions Less pain Less postoperative ileus
LC vs OC Treatment of Acute Cholecystitis Conversion rate: 15% l Operationg time: 88 vs 77 mins l Complication: 14% vs 23% l Hospital stay: 3. 3 vs 8. 1 days l Laparoscopic cholecystectomy vs Open cholecystectomy in the treatment of acute cholecystitis(ARCH SURG volume 133)
Anesthetic management Anesthetic technique l Regional anesthesia l l Thoracic epidural anesthesia(T 2) Advantage: l l Awake Protective airway reflex Shorter recovery Disadvantage: l l l Diaphragm irritation Significant nausea and vomiting Referred pain : neck and shoulder
Anesthetic management Anesthetic technique General anesthesia l Cuffed endotracheal tube placement l Controlled ventilation l Urinary catheter and nasogastric tube l
Open cholecystectomy : 5 -15 inches
Laparoscopic cholecystectomy : 1/4 -1/2 three or four incisions
LC-surgical technique Reverse Trendelenburg position Intraperitoneal CO 2 insufflation
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Complications in Laparoscopy How to stay out -of-trouble Gandsas
Complications in Laparoscopy How to stay out -of-trouble • Trendelenburg Gandsas
Complications in Laparoscopy How to stay out -of-trouble • Trendelenburg • Elevate abd. wall Gandsas
Complications in Laparoscopy How to stay out -of-trouble • Trendelenburg • Elevate abd. wall • 45 degrees Gandsas
Complications in Laparoscopy How to stay out -of-trouble • Trendelenburg • Elevate abd. wall • 45 degrees • Stay in midline Gandsas
Complications in Laparoscopy How to stay out -of-trouble • Trendelenburg • Elevate abd. wall • 45 degrees • Stay in midline • 15 mm Hg 15 mm. Hg Gandsas
Complications in Laparoscopy How to stay out -of-trouble • Trendelenburg • Elevate abd. wall • 45 degrees • Stay in midline • 15 mm Hg • Inspection Gandsas
LC-surgical technique
Laparoscopic Cholecystectomy
Complications in Laparoscopy Hasson Closed (n=12, 444) (n=489, 335) Vascular Injuries (%) 0 0. 08 Intestinal Injuries (%) 0. 05 0. 08 Bonjer HJ. Br J Surg. 1997; 84: 599 -602 Gandsas
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy
Laparoscopic Cholecystectomy Away from The CBD Lateral Retraction
Anesthetic management Post operative pain relief Wound infiltration with local anesthesia and NSAID - for peripheral pain l Opioids - for central pain l Ondansetron – for nausea and vomiting l
Lap CBD stone extraction : x-ray showing stone—flexible scope and basket used fore extraction
Missed CBD stone
ERCP : Balloon stone extraction
ERCP with sphincterotomy and stone extraction
Opening of BD---Widely open after sphincterotomy stones coming out
Take a rest……
THANK YOU
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