Background
Laparoscopic cholecystectomy is a routine surgical procedure to treat patients with acute cholecystitis. Those with complications due to acute cholecystitis are usually unsuitable for emergency laparoscopic cholecystectomy because of sepsis and various co-morbidities. Percutaneous transhepatic gallbladder drainage (PTGBD) is an interim strategy for stabilising the patient.1 However, in laparoscopic cholecystectomy following PTGBD, surgeons still face challenges such as tissue adhesion and hardness; as a result, a standard four-port laparoscopic cholecystectomy is necessary. The lateral right subcostal port functions as a gallbladder fundus retractor, which facilitates the Calot’s triangle dissection. Some innovative techniques have been developed to replace the fourth port in uncomplicated gallstone disease cases.2,3 We describe a novel technique of using a PTGBD pigtail catheter as a gallbladder fundus retractor in acute cholecystitis.
Technique
Laparoscopic cholecystectomy is usually scheduled three weeks following PTGBD. An 8Fr pigtail catheter (Skater™ drainage catheter with locking pigtail; Argon, Plano, TX, US) is left in situ and not removed (Fig 1). As carbon dioxide pneumoperitoneum is established via the umbilical port, and the epigastric and medial right subcostal ports are created, the pigtail catheter is pulled upwards to act as the fourth port to lift the gallbladder fundus (Fig 2). This technique facilitates the dissection of Calot’s triangle and achieves satisfactory haemostasis. After gallbladder removal, the curved catheter tip and thread can be seen well fixed in the liver bed and serving as an anchor (Fig 3).
Figure 1.
The pigtail catheter is left in situ.
Figure 2.
The pigtail catheter is pulled to lift the gallbladder fundus.
Figure 3.
The curved catheter tip and thread act as an anchor for the liver.
Discussion
This technique can reduce the number of ports used in laparoscopic cholecystectomy following PTGBD in patients with acute cholecystitis.
References
- 1.Na BG, Yoo YS, Mun SP et al. The safety and efficacy of percutaneous transhepatic gallbladder drainage in elderly patients with acute cholecystitis before laparoscopic cholecystectomy. Ann Surg Treat Res 2015; : 68–;73. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Balamoun H, Marzouk D. Simple technique for retraction of the gallbladder in laparoscopic cholecystectomy. Ann R Coll Surg Engl 2010; : 530–531. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Jategaonkar PA, Yadav SP. Mirroring dynamic gallbladder retraction of conventional laparoscopic cholecystectomy at the transumbilical approach. Ann R Coll Surg Engl 2014; : 167–168. [DOI] [PMC free article] [PubMed] [Google Scholar]