Laparoscopic Cholecystectomy Performed Immediately after Cesarean Section without Additional Incisions: A New Method

摘要

Aim: To describe a new technique in which laparoscopic cholecystectomy can be performed through trocar cannulas inserted directly through the same incision used for the cesarean section, without the need for additional incisions elsewhere. Presentation of Case: A 30-year-old pregnant woman presented with symptomatic cholelithiasis. Laboratory and radiological investigations revealed no signs of cholecystitis or pancreatitis. She had previously undergone cesarean section, so this was planned for the current birth as well, to be followed immediately by laparoscopic cholecystectomy. In week 38 of gestation, under general anesthesia and with a standard Pfannenstiel incision, a cesarean section was successfully performed. Thereafter, a laparoscopic cholecystectomy was performed through the same incision. The patient was discharged without any problem. Discussion: For patients with symptomatic gallbladder stones who undergo cesarean section, treatment options include laparoscopic cholecystectomy performed immediately after cesarean section during the same operative session, either with the standard technique or with the use of the cesarean incision in addition to other incisions. Technical difficulties of laparoscopic cholecystectomy performed through Pfannenstiel incision is the main concern of this method; however, the laxity of the abdominal wall due to enlarged uterus and hormonal changes during pregnancy facilitate laparoscopic maneuvers. Conclusion: Our technique, by making use of the cesarean incision alone, provides for easy gallbladder removal while also minimizing the risk of port related injury, reducing postoperative pain and providing better cosmetic results due to the absence of additional incisions; therefore can be considered in selected patients.