PEDICLE-AND-BED HYDRODISSECTION IN DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY | ||
| The Egyptian Journal of Surgery | ||
| Volume 20, Issue 2, April 2001, Pages 516-528 PDF (1.1 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejsur.2001.376371 | ||
| Author | ||
| Mohamed El-Sherif El-Sarky* | ||
| Department of Surgery, Faculty of Medicine, Cairo University, Egypt | ||
| Abstract | ||
| Intense acute inflammatory reaction, as in acute cholecystitis, and extensive vascularity and bleeding, as in liver cirrhosis, portal hypertension and coagulopathy, present distressing difficulties during laparoscopic cholecystectomy. In this work, hydrodissection was employed to overcome these difficulties. Injection of saline under pressure is done into tissue planes at selected points creating aqueous dissection zones. At the pedicle, inflation of tissue planes makes identification and dissection of structures more feasible, safer, and less bloody. At the bed, the aqueous zone at the cholecysto-hepatic boundary results in full separation from the liver with faster dissection, easier hemostasis and lesser chance for wall perforation. This study compares 37 patients (group A) who had this technique with 22 others who did not, though they had its indications (group B). Total operation time was shorter in group A (58.2±12.7 versus 74.1±23.5 minutes) and so were pedicle dissection time (11.4±5.5 versus 19.7±13.8 minutes) and bed workup time (7.2±2.2 versus 14.0±3.4 minutes). Group A patients had a lower incidence of conversion (0/37 versus 3/22), lower need for blood transfusion (0/37 versus 2/22), lower incidence of gallbladder perforation and stone spillage (1/37 versus 4/22) and lower need for a drain (1/37 versus 8/22). Both groups had comparable average duration of stay in hospital (2.7±1.3 versus 2.5±1.9 days) but group A patients returned faster to full activity (5.7±4.6 versus 9.8±7.6 days). Results of this work encourage the use of this method in difficult laparoscopic cholecystectomy. | ||
| Keywords | ||
| Difficult cholecystectomy; hydrodissection; gallbladder pedicle; gallbladder bed | ||
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