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Laparoscopic cholecystectomy in multiple laparotomy Crohn's disease
A Mahadevan1, R J Delicata, M K Roy
1University of Wales College of Medicine.
Insights
Laparoscopic cholecystectomy is safe for Crohn's disease patients with adhesions. Careful pneumoperitoneum establishment allows safe adhesiolysis, making the procedure feasible.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
Background:
- Crohn's disease patients often have multiple abdominal adhesions from prior surgeries.
- These adhesions complicate procedures like cholecystectomy.
- Gallstone incidence is higher in Crohn's disease patients.
Observation:
- Laparoscopic cholecystectomy was performed in three Crohn's disease patients with extensive adhesions.
- The procedure required specific precautions during pneumoperitoneum establishment.
- Adhesiolysis was successfully performed in all cases.
Findings:
- The average operative time was 75 minutes.
- Average hospital stay was 2 days.
- Minimal blood loss and no postoperative complications were observed.
Implications:
- Laparoscopic cholecystectomy is a feasible and safe option for Crohn's disease patients with adhesions.
- Careful surgical technique, particularly during pneumoperitoneum, is crucial.
- This approach may reduce morbidity compared to open surgery.
Abstract:
Patients with complicated Crohn's disease often require several surgical procedures resulting in multiple adhesions. They also have an increased incidence of gallstones. Laparoscopic cholecystectomy is associated with several advantages but is problematic for the inexperienced surgeon in the presence of multiple adhesions. Laparoscopic cholecystectomy was performed successfully in three patients with Crohn's disease who had previous extensive abdominal surgery. The average operative time was 75 min, with an average hospital stay of 2 days and minimal blood loss. There were no postoperative complications. Provided specific precautions are taken during establishment of the pneumoperitoneum, an adequate adhesiolysis can be performed, rendering laparoscopic cholecystectomy feasible and safe in such patients.