Summary
An unsolved problem of laparoscopic cholecystectomy is the optimal method of removing the gallbladder with thick walls and a large stone burden. Proposed solutions include fascial dilatation, stone crushing, and ultrasonic, high-speed rotary, or laser lithotripsy. Our observation was that extension of the fascial incision to remove the impacted gallbladder was time efficient and did not increase postoperative pain. We reviewed the narcotic requirements of 107 consecutive patients undergoing laparoscopic cholecystectomy. Fifty-two patients required extension of the umbilical incision, and 55 patients did not have their fascial incision enlarged. Parenteral meperidine use was 39.5±63.6 mg in the patients requiring fascial incision extension and 66.3±79.2 mg in those not requiring fascial incision extension (mean ± standard deviation). Oral narcotic requirements were 1.1±1.5 doses vs 1.3±1.7 doses in patients with and without incision extension, respectively. The wide range of narcotic use in both groups makes these apparent differences not statistically significant. We conclude that protracted attempts at stone crushing or expensive stone fragmentation devices are unnecessary for the extraction of a difficult gallbladder during laparoscopic cholecystectomy.
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References
Adwers JR, Mardis HK (1991) Laparoscopic cholecystectomy: the role of the pulsed dye laser in large gallstone fragmentation prior to removal. (Abstract) SAGES Proceedings, 1991, Monterey, CA
Dubois F, Berthelos G, Levard H (1990) Coelioscopic cholecystectomy: a preliminary report of 36 cases. Ann Surg 211: 60–62
Perissat J, Collett D, Vitale G, Belliard R, Sosso M (1991) Laparoscopic cholecystectomy using intracorporeal lithotripsy. Am J Surg 161: 371–376
Peters JH, Ellison EC, Innes JT, Liss JL, Nichols KE, Lomano JM, Roby SR, Front ME, Carey LC (1991) Safety and efficacy of laparoscopic cholecystectomy. A prospective analysis of 100 initial patients. Ann Surg 213: 3–12
Sackier JM, Berci G, Hunter JG, Endo CM, Crease J, Spaeth EE, Soerenson JT. A device for rapid removal of gallstones during laparoscopic cholecystectomy. (in press) Surg Endosc.
Zucker KA, Bailey RW, Gadacz TR, Imbembo AL (1991) Laparoscopic guided cholecystectomy. Am J Surg 161: 36–44
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Bordelon, B.M., Hobday, K.A. & Hunter, J.G. Incision extension is the optimal method of difficult gallbladder extraction at laparoscopic cholecystectomy. Surg Endosc 6, 225–227 (1992). https://doi.org/10.1007/BF02498808
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DOI: https://doi.org/10.1007/BF02498808