Acute Cholecystitis Case Study

PREOPERATIVE DIAGNOSIS: Acute cholecystitis.

POSTOPERATIVE DIAGNOSIS: Acute cholecystitis.

PROCEDURE: Laparoscopic cholecystectomy.

SURGEON: Dr. ___[NAME].

DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and after induction a general endotracheal anesthetic, the abdomen was prepped and draped in a sterile manner. Then, 0.5% Marcaine was injected superior to the umbilicus and a longitudinal skin incision was made and carried down to the anterior abdominal wall fascia which was incised in the midline. Two stay sutures of 0 Vicryl placed on either side of the fascial incision. The peritoneum was entered under direct vision with Mayo scissors. A Hassan trocar is inserted into the peritoneal cavity and secured to the

fascia, which was previously placed stay sutures. The peritoneum was inflated to a pressure of 15 mmHg with carbon dioxide.

The laparoscope was inserted and the remaining ports were placed visualizing their placement with a laparoscope. An 11 mm port was placed in the subxiphoid location, and two 5 mm ports were placed laterally under the right subcostal (rib) margin. The gallbladder was identified. It was edematous, acutely inflamed. It was grasped with the fundus and retracted in a (cephalad) direction. There were no omental adhesions adherent to the gallbladder that were taken down sharply. The neck was then grasped along the lateral most ports and retracted in a lateral direction. The cone bile duct was identified and care taken to avoid injury to this structure. The cystic artery and cystic duct were identified, mobilized, doubly ligated with endoclips and then divided. The gallbladder was dissected free from the liver with the electrocautery. The specimen was placed in an (Endo Catch) (sac), and was removed through the umbilical incision with no difficulty. The Hassan trocar was reinserted into the abdomen, reinflated the suprahepatic lymphatic space was irrigated copiously with normal saline. Adequate hemostasis was obtained in the gallbladder fossa with the electrocautery. The 360 degree

view of the abdomen was made with the scope. There were some adhesions in the right lower quadrant. The stomach and duodenum appeared normal, as did transverse and sigmoid colons. Trocars were then removed, while visualizing their removal with the laparoscope. No bleeding was noted from any of the trocar sites, intraperitoneally. The Hassan trocar was removed last. The fascia at the umbilicus closed with a Vicryl figure of 8 sutures. The skin incision was closed with 4-0 Monocryl (running) subcuticular sutures. The (wounds) were (dressed) and the patient was taken to the recovery room in good condition.