By Gregory E. Jeansonne
38yo">
By Gregory E. Jeansonne
38yo, White Female, G6P5106 with 4 vaginally, 1 by Low Transverse C-Section, and 1 by Classical C-section with Bilateral Tubal Ligation. No other Surgical History. No other medical problems.
Complains of RUQ pain which does not radiate. Pain is intermittent. She has had similar episodes of intermittent pain in the past most recently after Jazz Fest (high fat foods) but they have always resolved on their own. No evidence of jaundice. U/S revealed numerous stones within gallbladder.
1. Patient preped and draped in the usual sterile fashion.
2. Laparoscopic equipment arranged and assembled.
3. Abdominal wall incised, insoflated, & trochar inserted at the midline 5-6cm above the umbilicus.
4. Additional trochars inserted with laparoscopic guidance in RUQ at mid-clavicular and anterior axillary lines 2-4cm inferior to the costal margin. Lights dimmed after insertion to facilitate video observation.
5. Extensive adhesions were found probably related to prior c-sections. After several attempts at alternate pathways, the laparoscopic approach was determined to be too difficult at which time trochars were removed and the abdomen deflated.
6. Trochar sites were extended and joined for easy abdominal access.
7. Cystic duct and vessels were identified, separated, ligated, and divided.
8. The cystic pedicle was then clamped and traction applied to facilitate removal of the gallbladder from its hepatic recess. Hemostasis was obtained primarily with electro-cautery although several larger vessels required ligation and division.
9. The abdominal cavity was irrigated with 1 liter warm normal saline and suctioned with a bowel guard suction catheter.
10. Fascia was closed with #1 vicryl using a running technique. Subcutaneous fat was not closed separately as it was judged too this to justify the additional layer. Skin was closed with staples.
11. The gallbladder was found to contain several primarily cholesterol stones in the 5-10mm range.
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Revised: 05 August, 2002
