A&P Basics                BIOL 2404                  Case Study: GI                        Dr. Weis

Surgical Referral Group                               Operative Report

Preoperative Diagnosis:          Cholangitis, Cholecysitis, Cholelithiasis

Operation scheduled:              Laparoscopic cholecystectomy

Indications:                             52 year old male with history of right hypochondriac

                                                regional pain that radiates to the posterior right scapula

                                                after a fatty meal. Intermittant colicky pain was reported

                                                over several days.  Abdominal ultrasound revealed five

                                                calculi, three in the gall bladder and two in the cystic duct.

                                                Partial duct obstruction was suspected.

Surgical Procedure:               

The patient was prepped and placed in dorsal recumbency.  A 2.5 cm transverse incision was made inferior to the umbilicus and the superficial fascia was opened for insertion of CO2 gas. Another incision was made in the subxiphoid region and two other openings in the usual positions for insertion of the light and other laparoscopic equipment.

The liver and gallbladder were identified and the cystic duct was revealed.

A cholangiogram was performed and revealed no calculi in the hepatic duct or common bile duct.  The cystic duct was ligated using clips and transected  and the cystic artery was also ligated.  The gall bladder was dissected free and extracted through the xiphoid opening.

The five stones were found as shown in the ultrasound exam. The stones and gall bladder were sent to pathology for analysis and culture.

All laparoscopic instruments were removed and the umbilical and subxiphoid incisions were closed using Dermalon.  The incisions were bandaged for the post operative recovery period.

Postoperative Diagnosis:        chronic cholecystitis, cholelithiasis

Operation Performed:             Laparoscopic cholecysectomy