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Laparoscopic cholecystectomy and previous abdominal surgery: a safe technique
1Department of Surgery, Hornsby-Kuringai District Hospital, Sydney, New South Wales, Australia.
Summary
Laparoscopic cholecystectomy is safe after prior abdominal surgery. A novel technique using an open Hasson cannula in the right iliac fossa allows safe port placement and avoids complications, making previous surgery not a contraindication.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Previous abdominal surgery is often considered a contraindication for laparoscopic cholecystectomy.
- Adhesions from prior surgeries can complicate laparoscopic procedures.
Purpose of the Study:
- To describe a safe technique for laparoscopic cholecystectomy in patients with previous abdominal surgery.
- To evaluate the feasibility and safety of this modified approach.
Main Methods:
- Open introduction of a Hasson cannula in the right iliac fossa, similar to an appendicectomy.
- Laparoscope insertion through the primary port to identify and divide adhesions.
- Conventional laparoscopic cholecystectomy after establishing safe port placement.
Main Results:
- The technique was successfully applied in six patients with abdominal scars.
- No complications or conversions to laparotomy were reported.
- Operating time increased from 75 to 105 minutes.
Conclusions:
- This modified open primary trocar insertion technique is safe for laparoscopic cholecystectomy in patients with prior abdominal surgery.
- Previous abdominal surgery should not be an absolute contraindication for this procedure.