Image Category: Fundamentals: Laparoscopic Cholecystectomy

Cholecystoduodenal fistula

A cholecysto-duodenal fistula is a connection between the gallbladder and the duodenum. It may occur as an uncommon complication of chronic cholecystitis when the gall bladder becomes adherent to the adjacent duodenum and a stone ulcerates through the wal

cholecystoduodenal fistula

50 year old female who presented with repeated attacks of RUQ pain. CT scan showed pneumobilia and cholecystoduodenal fistula, which was confirmed intraoperatively.

Spaghetti Maneuver

Rolling long GB around the grasper Facilitate grasping and dissection in long Gall bladders. Especially useful in SILS.

Spaghetti Maneuver

Rolling long Gall bladder around the grasper Facilitate grasping of and dissection in such Gall bladders.

Critical View

To perform a safe Laparoscopic Cholecystectomy, demonstration of the critical view following dissection of the triangle of Calot is essential. Laparoscopic view – Cystic Duct & Artery, CBD are shown.

Cystic duct drain into right hepatic duct

37 year old female with acute cholecytitis secondary to multiple gallstones. Very short cystic duct noted. Cholangiogram cathether inserted only 1 cm. Drainage directly in right hepatic duct noted.

Right hepatic artery anterior to common hepatic duct

The right hepatic artery crosses anterior to the CHD in 12% of patients. Left panel shows initial view and the potential for injury to CBD or Right hepatic artery as seen in the right panel after complete dissection

Fundus-down Laparoscopic Cholecystectomy

Fundus-down approach (retrograde dissection).Surgical field—Laparoscopic view of fundus-down approach. Liver(Gall bladder Bed)[asterisk]; Fistula between gall bladder neck and duodenum(arrow); fundus of gall bladder over the grasper after FDA (arrow).

Fundus-down Laparoscopic Cholecystectomy

Fundus-down approach (retrograde dissection).Surgical field—Laparoscopic view of fundus-down approach. Liver(Gall bladder Bed)[asterisk]; Fistula between gall bladder neck and duodenum(arrow).

Fundus-down Laparoscopic Cholecystectomy

Fundus-down approach (retrograde dissection).Surgical field—Laparoscopic view of fundus-down approach. Liver(Gall bladder Bed)[asterisk]; Fistula between gall bladder neck and duodenum(arrow).

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