Experience with single-incision laparoscopic cholecystectomy in patients with previous upper abdominal surgery

Nana Makino, MD, Nobumi Tagaya, PhD, Yawara Kubota, MD, Kazuyuki Saito, MD, Takashi Okuyama, PhD, Yoshitake Sugamata, PhD, Hidemaro Yoshiba, PhD, Masatoshi Oya, PhD

Department of Surgery, Dokkyo Medical University Koshigaya Hospital

Background: Single-incision laparoscopic cholecystectomy (SILC) is an emerging procedure developed to decrease parietal trauma and improve esthetic outcomes. However, in general, the patients with previous upper abdominal surgery (PUAS) are still excluded for this technique. We reported our experience of SILC for the patients with PUAS.

Materials and methods: Recent one year, we performed consecutive SILCs in 40 patients. Five (12.5%) of them had PUAS. They are 4 males and one female, and the mean age was 64 years. PUAS included 2 distal gasterctomies due to gastric ulcer, one laparoscopic-assisted distal gastrectomy due to gastric cancer, one lysis of duodenal adhesion due to ileus, and one urostomy with parastomal hernia due to bladder cancer. Under general anesthesia, 2.5-cm transumbilical skin incision was made. Lap-protector was applied and covered by glove. Three 5-mm ports were inserted into the peritoneal cavity through the glove. We used hands-free retraction system, flexible port and pre-bending forceps to retract or divide. Intraperitoneal adhesions were moderate in all patients. After obtaining the critical view, the cystic artery was divided using laparoscopic coagulating shears and the cystic duct was also divided after clipping. The gallbladder was freed from the liver bed and retrieved through the umbilicus.

Results: There was no additional port or conversion to standard LC and open procedure. The mean operation time was 125 min and the estimated blood loss was minimal. The crushing between the instruments or laparoscope and 5-mm instruments was reduced by hands-free retraction system, flexible port and pre-bending forceps. The mean postoperative hospital stay was 3 days. There were no postoperative complications.

Conclusion: SILC is a feasible and safe procedure to perform laparoscopic cholecystectomy even in the patients with PIAS. PUAS is not a contraindication for SILC.

Session: Poster Presentation

Program Number: P333

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