OPERATION: Laparoscopic Cholecystectomy with On-Table Cholangiogram
ANAESTHETIC: General anaesthesia
FINDINGS: Enlarged gallbladder. On-table cholangiogram demonstrated stones in the common bile duct.
PROCEDURE:
Supraumbilical open Hasson 10mm port.
10mm epigastric, 5mm right subcostal and 5mm right lumbar ports under direct vision.
Correct identification of anatomical structures.
Cystic duct and cystic artery identified and dissected. Critical view of safety achieved.
On-table cholangiogram performed - stones identified in common bile duct.
Hem-o-lok clips applied and structures divided.
Cholecystectomy performed in standard fashion.
Haemostasis and biliostasis confirmed.
Suction irrigation. 24F drain placed in right subphrenic area.
Gallbladder brought out using retrieval bag.
CLOSURE:
No.1 PDS sutures to fascia at umbilical port. 3-0 Monocryl to skin.
POST-OPERATIVE INSTRUCTIONS:
Continue IV antibiotics 48 hours.
Urgent inpatient ERCP required.
Dalteparin at 18:00. Regular observations. Drain emptied at 08:00 daily.