[Laparoscopic cholecystectomy in patients who previously underwent major laparotomy]

This paper describes the experience gained and the techniques used by the authors in the laparoscopic treatment of biliary calculosis in patients who previously underwent abdominal surgery, excluding cases with incisions below the horizontal line passing through the umbilicus (in these cases there are usually no adhesions to hinder operative laparoscopy of the gallbladder). Between October 1991 and July 1995,776 laparoscopies were performed on bile ducts (715 for calculosis of the gallbladder and 61 for cholecysto-choledochal calculosis). In 18 cases there was scarring of the abdominal wall due to previous major surgery (12 gastric resections, 3 resections of the colon, 1 splenectomy, 1 case of fundoplication for hiatal hernia, 1 resection of the ileum). In all cases access was by open laparoscopy to the lower right or periumbilical abdominal quadrant. When necessary, local viscerolysis was performed using various techniques with variations depending on the adhesions encountered. In all cases surgery was performed laparoscopically. In 2 cases a calculosis of the common bile duct was treated at the same time. The average duration of surgery was 70 min for cholelithiasis and 145 min for cholecysto-choledochal calculosis. On average patients were released from hospital 4 and 7 days after surgery respectively. No major or minor complications were encountered.