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| Name | Laparoscopic Cholecystectomy in a case of Acute Calculus Cholecystitis with Hepatic Cirrhosis |
| Video Uploader | Video From Dr Rajesh Patil |
| Upload Date | This Video Uploaded At 03-03-2020 10:44:15 |
| Video Discription | A elderly obese male with alcoholic liver disease presented with features of acute cholecystitis.Ultrasonography showed thick walled, distended gall bladder with calculus measuring 3cm and a cirrhotic liver.As patient was not improving clinically and had a good ASA score with child pugs A Score a laparoscopic cholecystectomy was advised.Laparoscopic cholecystectomy was performed with standard four port technique under general anaesthesia. Pnuemoperitoneum was created through the first port subumbilicallyby means of the open(Hassan) technique to avoid injury to the recannulated umbilical vein. Gallstones are more common in cirrhotic patients then non cirrhotics due to factors like increased levels of estrogen,functional alterations of the gall bladder like reduction in motility and emptying,hemolysis and hypersplenism.Patientswithchronicliver disease are at increased risk for mortality and morbity when undergoing any abdominal surgery. Cholecystectomy in particular may be more hazardous in cirrhosis because of haemorrhage related to portal hypertension, coagulopathy and thrombocytopenia. In addition, the reduced compliance of the fibrotic liver makes the retraction and exposure of Calot’s triangle more difficult laparoscopically. Laparoscopic cholecystectomy in cirrhotics is controversial,however with surgeons increase in laparoscopic experience,proper patient selection and with normal hepatic synthetic function, laparoscopic cholecystectomy is safer and better tolerated then open cholecystectomy especially in child-pugh class A and B group of patients.Appropriate preoperative preparation,better treatment of liver failure and careful intraoperative techniques are required for better outcomes. |
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