Derici Hayrullah, Bozdağ Ali Doğan, Tansug Tugrul, Nazli Okay, Reyhan Enver
Izmir Atatürk Training and Research Hospital, Third Surgical Clinic, Turkey.
Surg Laparosc Endosc Percutan Tech. 2007 Dec;17(6):521-3. doi: 10.1097/SLE.0b013e3181469ed2.
Perforation of the gall bladder is a frequent complication during laparoscopic cholecystectomy. Grasping the perforated part of the gall bladder, clip application, or endoscopic loop application are possible solutions to prevent spillage. We propose laparoscopic rubber band application to close the perforated part of the gall bladder as an easy and safe method. We performed rubber band application after iatrogenic perforation of the gall bladder during laparoscopic cholecystectomy in 5 patients. Two-millimeter-wide multiple rubber rings, cut from a 14-Fr Foley catheter, are loaded on a grasper. When a perforation occurred during the dissection of the gall bladder, the hole is grasped with this instrument and 1 of the rings is placed on the gall bladder by the aid of a dissector. Thus, the grasper remained available for traction of the Hartmann's pouch during further dissection of the gall bladder. The rubber bands were placed successfully in all cases. Two perforations occurred in 1 case, and 2 bands were placed with ease. Bile leakage or gall stone spillage did not occur. Operation time was not prolonged. Rubber band ligation of perforation of the gall bladder is a simple, safe, inexpensive, and effective method to prevent spillage of the bile or gallstones in laparoscopic surgery.
胆囊穿孔是腹腔镜胆囊切除术常见的并发症。抓住胆囊穿孔部位、应用夹子或内镜套圈是防止胆汁外溢的可行方法。我们提出应用腹腔镜橡皮筋来闭合胆囊穿孔部位，这是一种简便且安全的方法。我们对5例在腹腔镜胆囊切除术期间发生医源性胆囊穿孔的患者应用了橡皮筋。从14F Foley导管上剪下的2毫米宽的多个橡胶环套在抓钳上。当在胆囊解剖过程中发生穿孔时，用该器械抓住穿孔部位，并在剥离器的辅助下将其中一个环套放置在胆囊上。这样，在进一步解剖胆囊时，抓钳仍可用于牵拉哈特曼袋。所有病例中橡皮筋均成功放置。1例出现2处穿孔，轻松放置了2个橡皮筋。未发生胆汁漏或胆结石外溢。手术时间未延长。胆囊穿孔的橡皮筋结扎术是一种简单、安全、廉价且有效的方法，可防止腹腔镜手术中胆汁或胆结石外溢。
