A modified technique of gallbladder dissection from the liver during laparoscopic cholecystectomy. Personal technique

Background Gallbladder injures during cholecystectomy happens more frequently when surgical operation is conduced under laparoscopic (16%) rather than laparotomic (8%) access. A modification of the technique of dissectionof the gallbladder from the liver is presented, suggesting a progression from the medium to the lateral side. This technique should facilitate the division of the organs and, above all, limit the gallbladder iatrogenic injures. Methods. During 1995-2000 we have employed our technique in 637 patients, 89 (14%) affected by acute cholecystytis, subjected to laparoscopic cholecystectomy. Results. Gallbladder injures occurred in 38 cases (6%), with stones liberation 12 (1,9%): 11 had been submitted to surgery in emergency. All patients have been subjected to follow-up from 12 to 30 months. No intraperitoneal abscess was observed, while suppuration of the umbilical port occurred in 12 patients (1,9%): 6 were affected by systemic illnesses. Conclusions. Our technique can limit the incidence of iatrogenic gallbladder injuries during laparoscopic cholecystectomies, reducing surgical times, antibiotics administration, incidence of perioperative complications. Besides, this technique may facilitate the gallbladder dissection from the liver in case of infundibular stones.