Department of Surgery, Saiseikai Wakayama Hospital, Wakayama City, Japan.
Department of Gastroenterology, Saiseikai Wakayama Hospital, Wakayama City, Japan.
Asian J Endosc Surg. 2022 Apr;15(2):372-375. doi: 10.1111/ases.13007. Epub 2021 Nov 2.
Laparoscopic subtotal cholecystectomy, a bailout surgery for cholecystitis, can result in postoperative bile leakage, so surgical ingenuity is required. An 88-year-old woman had pain at the right hypochondrium. Abdominal computed tomography showed swelling of the gallbladder and thickness of the gallbladder wall, leading to diagnosis of mild acute cholecystitis. Percutaneous transhepatic gallbladder drainage was performed to alleviate cholecystitis because the patient was taking antiplatelet medicine. Laparoscopic cholecystectomy was then performed within 72 hours from the onset. The gallbladder was operatively found to be strongly fibrotic, so the procedure was switched to laparoscopic subtotal cystectomy, dissecting the gallbladder at the infundibulum-cystic duct level. The gallbladder stump was closed with barbed suture and omentopexy was added due to fragility. There was no significant postoperative bile leakage. Additional omentopexy to stump closure in laparoscopic subtotal cholecystectomy was thought to be useful in prevention of postoperative bile leakage.
腹腔镜胆囊次全切除术是一种治疗胆囊炎的抢救性手术，可能导致术后胆漏，因此需要手术技巧。一位 88 岁女性出现右上腹痛。腹部 CT 显示胆囊肿胀和胆囊壁增厚，诊断为轻度急性胆囊炎。因患者正在服用抗血小板药物，故进行经皮经肝胆囊引流以缓解胆囊炎。发病后 72 小时内进行了腹腔镜胆囊切除术。术中发现胆囊强烈纤维化，因此手术改为腹腔镜胆囊次全切除术，在壶腹-胆囊管水平解剖胆囊。由于胆囊残端脆弱，使用带刺缝线关闭胆囊残端，并进行大网膜固定。术后无明显胆漏。腹腔镜胆囊次全切除术中，残端关闭附加大网膜固定被认为有助于预防术后胆漏。
