LAPAROSCOPIC SURGERY IN BILIARY DISEASES

Abstract

The firstphase was carried out on 87 patients with gallbladder disease, their ages ranged from 25-62 years . most of these patients were females (69 cases). Four of these patients had previous abdominal operation, nine had hypertension, six had ischemic heart disease, seven had diabetes mellitus, two had both diabetes mellitus and hypertension and five had morbid obesity.

Intraoperative cholangiography was tried in only 48 patients and was successful in 45 and revealed filling defect in 2 patients for whom ERCP revealed stones in only one of them. Intraoperative cholangiography failed due to small common bile duct in 2 patients and its avulsion in the third patient.

Severely inflamed gallbladder was found intraoperatively in 9 cases. The best initial maneuver to deal with was aspiration through the fundus.

Wide cystic duct was found in 3 cases. These ducts were occluded by extraperitoneal knots.

In 4 cases with previous abdominal surgery. Only, adhesions that prevent access to the gallbladder were cut by scissors. In 5 cases with morbid obesity long instruments were used. Intraoperative conversion to open surgery was done in 6 patients among them 3 patients had uncontrolled bleeding from the cystic artery, 2 had severe adherence of the Hartman's pouch to the common bile duct. Dissection of the former from the latter in one of them lead to injury of the latter transversely. In the