Cholecystectomy and Choledocholithotomy under Laparotomy

Takashi Matsushiro

Surgical Division, Tohoku Rosai Hospital

The author discusses the basic procedures of cholecystectomy and choledochotomy under laparotomy as well as the problems associated with these procedures. At the time of cholecystectomy, cholecystectomy from the fundus should be selected in the first place. In cholecystectomy after the course of acute cholecystitis, it is not necessary to stick with typical surgical procedures, but it is important to incise the gallbladder first and to carry out the procedure while making sure of the anatomical relationships with the surrounding organs. The author emphasizes that preventive drainage after cholecystectomy may be withdrawn the next day if there are no accidents or problems. Choledochotomy is applicable to choledocholithiasis, and in addition to cases of cholecystolithiasis where previous jaundice suggesting biliary infection and choledochal dilatation are recognized. In cases in which a number of small calculi are seen in the gallbladder, cystic duct dilatation and a contracted gallbladder without calculus suggest escape of a gallstone into the choledochus. Therefore, detailed inspection is required during surgery. Choledochal drainage using a T-tube subsequent to choledochotomy should be carried out in cases where complications of biliary infection, choledochal dilatation, and copious biliary sand and mud are recognized in the choledochus.

Key words
atypical cholecystectomy, intraoperative bile duct injury, indication of choledochotomy

Reprint requests
Takashi Matsushiro Surgical Division, Tohoku Rosai Hospital JAPAN

Accepted
May 11, 1993

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