In cholecystectomy, fresh plasma should be given
.Indications for cholecystectomy, * Gallstones--symptomatic. * Cholecystitis--acute, chronic. * Acalculous cholecystitis. * Empyema gallbladder. * Mucocele gallbladder. Approaches employed are * Open - Right subcostal incision (Kocher's). - Right paramedian. - Horizontal incision. - Mayo-Robson incision. * Laparoscopic approach. Technique After opening the abdomen, colon is pushed downwards and stomach medially. Duct--first method: Here Calot's triangle is dissected. Cystic aery is identified and ligated. Cystic duct is ligated close to the gallbladder. Gallbladder is separated from gallbladder fossa and removed. Haemostasis is maintained. Fundus--first method: It is done in difficult gallbladder due to dense adhesions. Fundus is separated from themliver bed. Dissection is carried proximally until cystic duct and cystic aery are identified, which are then ligated. Drain is placed, which is removed after 72 hours. On table cholangiogram is a must after cholecystectomy. ref : SRB&;s manual of surgery,3 rd ed,pg no 595
Just before operation
6 hours before operation
6 hours before operation
12 hour after operation
G.I.T