Laparoscopic Cholecystectomy for Empyema Gallbladder
Empyema with the gallbladder is marked by intense pain on the upper right side with the abdomen, high fever, and rigidity with the muscles over the infected area. Patients with the empyema gallbladder undergoing early operation by laparoscopic cholecystectomy in experienced hand without attempts at nonoperative treatment had less infectious morbidity and mortality. Despite various encouraging reports found is various literatures, the role of laparoscopic surgery in such acute conditions is still under evaluation. The surgeons are still looking to find out safety and outcome of LC in empyema gallbladder.
The main cause of complication of empyema gallbladder is delayed operative intervention, extrabiliary abscess, perforation of the gallbladder and common duct exploration are factors that help with increased risks during these patients. In case of thick pus the gallbladder in empyema should be incised and the suction cannula directly should be introduced into gall bladder to aspirate pus. At times the suction cannula or aspiration needle is also used and harmonic scalpel is used to dissect the dense adhesions in the area of Calot's triangle in case of empyemaa. The thickened wall of the gallbladder should also be incised to apply the graspers properly in cases where it was difficult to get hold of the thick, edematous gallbladder.
Laparoscopic cholecystectomy by expert laparoscopic surgeons can be performed in empyema of gallbladder keeping in mind a slightly increased risk of complications even in the best hands. However, the experience of the surgeon plays a key role in the overall outcome of this complicated situation.
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