Ileostomy site approach for adhesiolysis and laparoscopic cholecystectomy in a hostile abdomen: A novel technique

Introduction: Gallstones are an etiological factor in 23%-54% of patients with acute pancreatitis. A small proportion of these patients will also have intestinal complications requiring necrosectomy with diverting loop ileostomy. Later, these patients require cholecystectomy and ileostomy reversal....

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Bibliographic Details
Published in:Journal of minimal access surgery 2018-07, Vol.14 (3), p.261-263
Main Authors: Borle, Deeplaxmi, Agrawal, Nikhil, Arora, Asit, Kumar, Senthil, Chattopadhyay, Tushar
Format: Article
Language:English
Subjects:
Abdomen
Bile
Biliary pancreatitis
Care and treatment
Cholecystectomy
Comparative analysis
Development and progression
Fistula
Gallbladder
Gallbladder diseases
Gallstones
Gangrene
Histopathology
hostile abdomen
How I do it Differently?
Ileostomy
ileostomy closure
laparoscopic cholecystectomy
Laparoscopy
Liver
Ostomy
Pancreatitis
Surgery
Surgical techniques
Ventilation
Ventilators
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Summary:Introduction: Gallstones are an etiological factor in 23%-54% of patients with acute pancreatitis. A small proportion of these patients will also have intestinal complications requiring necrosectomy with diverting loop ileostomy. Later, these patients require cholecystectomy and ileostomy reversal. Laparoscopic cholecystectomy is fraught with difficulty in these patients due to dense intra-abdominal adhesions, and many surgeons resort to an open approach. We describe a technique which takes advantage of the ileostomy site for initial access. Materials and Surgical Technique: Ileostomy reversal is done and a SILS™ (Covidien, Mansfield, Massachusetts, USA) port is inserted under direct vision, through the ileostomy site. Adhesiolysis is done through the SILS™ port. Additional ports are inserted and standard steps are followed for cholecystectomy. Conclusion: The use of ileostomy incision as the first port facilitates adhesiolysis and subsequent port placement in the hostile abdomen encountered in these patients. We describe a novel technique of ileostomy reversal and laparoscopic cholecystectomy using SILS™ port.
ISSN:0972-9941
1998-3921
DOI:10.4103/jmas.JMAS_73_17