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Laparoscopic Cholecystectom Hamed Rashad

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.

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Laparoscopic Cholecystectom Hamed Rashad

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  1. Laparoscopic Cholecystectom Hamed Rashad

  2. Gall Bladder The gall bladder is the organ in the body responsible fore concentrating and storing bile

  3. Relations of GB to surroundings

  4. Usually G stones look like this

  5. Two large gall stones : Notice how they reflect back shadows

  6. Thick sludge in the gall bladder

  7. Gall stones seen in ordinary x-ray

  8. Laparoscopic Cholecystectomy(LC) • Indication: • Symptomatic gallstones • Other biliary tract disease • Difficult technical challenges • Acute cholecystitis • Obesity • Previous intra-abdominal surgery • Pregnancy

  9. Benefit of LC • Shorter hospital stays • More rapid return to normal activities • Small, limited incisions • Less pain • Less postoperative ileus

  10. LC vs OC • Treatment of Acute Cholecystitis • Conversion rate: 15% • Operationg time: 88 vs 77 mins • Complication: 14% vs 23% • Hospital stay: 3.3 vs 8.1 days Laparoscopic cholecystectomy vs Open cholecystectomy in the treatment of acute cholecystitis(ARCH SURG volume 133)

  11. Anesthetic management • Anesthetic technique • Regional anesthesia • Thoracic epidural anesthesia(T2) • Advantage: • Awake • Protective airway reflex • Shorter recovery • Disadvantage: • Diaphragm irritation • Significant nausea and vomiting • Referred pain : neck and shoulder

  12. Anesthetic management • Anesthetic technique • General anesthesia • Cuffed endotracheal tube placement • Controlled ventilation • Urinary catheter and nasogastric tube

  13. Open cholecystectomy :5-15 inches

  14. Laparoscopic cholecystectomy :1/4-1/2 three or four incisions

  15. LC-surgical technique • Reverse Trendelenburg position • Intraperitoneal CO2 insufflation

  16. Laparoscopic Cholecystectomy

  17. Laparoscopic Cholecystectomy

  18. Laparoscopic Cholecystectomy

  19. Complications in Laparoscopy Gandsas How to stay out-of-trouble

  20. Complications in Laparoscopy Gandsas How to stay out-of-trouble • Trendelenburg

  21. Complications in Laparoscopy Gandsas How to stay out-of-trouble • Trendelenburg • Elevate abd.wall

  22. Complications in Laparoscopy Gandsas How to stay out-of-trouble • Trendelenburg • Elevate abd.wall • 45 degrees

  23. Complications in Laparoscopy Gandsas How to stay out-of-trouble • Trendelenburg • Elevate abd.wall • 45 degrees • Stay in midline

  24. Complications in Laparoscopy 15 mmHg Gandsas How to stay out-of-trouble • Trendelenburg • Elevate abd.wall • 45 degrees • Stay in midline • 15 mm Hg

  25. Complications in Laparoscopy Gandsas How to stay out-of-trouble • Trendelenburg • Elevate abd.wall • 45 degrees • Stay in midline • 15 mm Hg • Inspection

  26. LC-surgical technique

  27. Laparoscopic Cholecystectomy

  28. Complications in Laparoscopy Gandsas Bonjer HJ. Br J Surg. 1997;84:599-602

  29. Laparoscopic Cholecystectomy

  30. Laparoscopic Cholecystectomy

  31. Laparoscopic Cholecystectomy

  32. Laparoscopic Cholecystectomy

  33. Laparoscopic Cholecystectomy

  34. Laparoscopic Cholecystectomy

  35. Laparoscopic Cholecystectomy

  36. Laparoscopic Cholecystectomy

  37. Laparoscopic Cholecystectomy

  38. Laparoscopic Cholecystectomy

  39. Laparoscopic Cholecystectomy

  40. Laparoscopic Cholecystectomy

  41. Laparoscopic Cholecystectomy

  42. Laparoscopic Cholecystectomy

  43. Laparoscopic Cholecystectomy

  44. Laparoscopic Cholecystectomy

  45. Laparoscopic Cholecystectomy

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