Laparoscopic cholecystectomy in patients with portal cavernoma without portal vein decompression
Introduction: Laparoscopic cholecystectomy (LC) in patients with extrahepatic portal vein obstruction causing portal cavernoma (PC) is considered high risk because of portosystemic collateral veins in the hepatocystic triangle. The literature is limited to isolated case reports. We describe our expe...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2021-01-01
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| Series: | Journal of Minimal Access Surgery |
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| Online Access: | http://www.journalofmas.com/article.asp?issn=0972-9941;year=2021;volume=17;issue=3;spage=351;epage=355;aulast=Sasturkar |
| _version_ | 1823929261118980096 |
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| author | Shridhar Vasantrao Sasturkar Nikhil Agrawal Asit Arora M. P. Senthil Kumar Ragini Kilambi Shalini Thapar Tushar Kanti Chattopadhyay |
| author_facet | Shridhar Vasantrao Sasturkar Nikhil Agrawal Asit Arora M. P. Senthil Kumar Ragini Kilambi Shalini Thapar Tushar Kanti Chattopadhyay |
| author_sort | Shridhar Vasantrao Sasturkar |
| collection | DOAJ |
| description | Introduction: Laparoscopic cholecystectomy (LC) in patients with extrahepatic portal vein obstruction causing portal cavernoma (PC) is considered high risk because of portosystemic collateral veins in the hepatocystic triangle. The literature is limited to isolated case reports. We describe our experience of LC in patients with PC.
Patients and Methods: Data of patients with PC who underwent LC for symptomatic gallstones or related complications was reviewed. Patients with simultaneous cholecystectomy with splenorenal shunt and open cholecystectomy were excluded. Pre-operative evaluation consisted of complete blood count, international normalisation ratio and liver function tests, ultrasound of the abdomen with Doppler, contrast-enhanced computerised tomography, magnetic resonance cholangiopancreatography and esophagogastroscopy as indicated. A standard four-port LC was performed. The technical principles followed were to avoid injury to the collateral veins, liberal use of energy sources and division of dominant collateral veins between clips.
Results: Seven adult patients including three females underwent LC. Three patients had thrombosis of previous surgical shunt with persistent PC. The remaining four patients did not have any indication for shunt surgery. Successful LC was performed in six patients. The median duration of surgery was 170 (130–250 min). Blood transfusion was not required. All the patients had uneventful post-operative recovery. The histopathology of gall bladder consists of acute cholecystitis in three patients and chronic cholecystitis in four.
Conclusion: LC is feasible in patients with PC at a centre with experience in both laparoscopic and portal hypertension surgeries. Excellent outcome with low rate of conversion to open surgery can be achieved. |
| first_indexed | 2024-12-16T21:07:03Z |
| format | Article |
| id | doaj.art-7d5af0e43b314d1c9d1f3b74ee49d070 |
| institution | Directory Open Access Journal |
| issn | 0972-9941 1998-3921 |
| language | English |
| last_indexed | 2024-12-16T21:07:03Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Minimal Access Surgery |
| spelling | doaj.art-7d5af0e43b314d1c9d1f3b74ee49d0702022-12-21T22:16:17ZengWolters Kluwer Medknow PublicationsJournal of Minimal Access Surgery0972-99411998-39212021-01-0117335135510.4103/jmas.JMAS_106_20Laparoscopic cholecystectomy in patients with portal cavernoma without portal vein decompressionShridhar Vasantrao SasturkarNikhil AgrawalAsit AroraM. P. Senthil KumarRagini KilambiShalini ThaparTushar Kanti ChattopadhyayIntroduction: Laparoscopic cholecystectomy (LC) in patients with extrahepatic portal vein obstruction causing portal cavernoma (PC) is considered high risk because of portosystemic collateral veins in the hepatocystic triangle. The literature is limited to isolated case reports. We describe our experience of LC in patients with PC. Patients and Methods: Data of patients with PC who underwent LC for symptomatic gallstones or related complications was reviewed. Patients with simultaneous cholecystectomy with splenorenal shunt and open cholecystectomy were excluded. Pre-operative evaluation consisted of complete blood count, international normalisation ratio and liver function tests, ultrasound of the abdomen with Doppler, contrast-enhanced computerised tomography, magnetic resonance cholangiopancreatography and esophagogastroscopy as indicated. A standard four-port LC was performed. The technical principles followed were to avoid injury to the collateral veins, liberal use of energy sources and division of dominant collateral veins between clips. Results: Seven adult patients including three females underwent LC. Three patients had thrombosis of previous surgical shunt with persistent PC. The remaining four patients did not have any indication for shunt surgery. Successful LC was performed in six patients. The median duration of surgery was 170 (130–250 min). Blood transfusion was not required. All the patients had uneventful post-operative recovery. The histopathology of gall bladder consists of acute cholecystitis in three patients and chronic cholecystitis in four. Conclusion: LC is feasible in patients with PC at a centre with experience in both laparoscopic and portal hypertension surgeries. Excellent outcome with low rate of conversion to open surgery can be achieved.http://www.journalofmas.com/article.asp?issn=0972-9941;year=2021;volume=17;issue=3;spage=351;epage=355;aulast=Sasturkarextrahepatic portal vein obstructionlaparoscopic cholecystectomyportal cavernomaportal cavernoma cholangiopathy |
| spellingShingle | Shridhar Vasantrao Sasturkar Nikhil Agrawal Asit Arora M. P. Senthil Kumar Ragini Kilambi Shalini Thapar Tushar Kanti Chattopadhyay Laparoscopic cholecystectomy in patients with portal cavernoma without portal vein decompression Journal of Minimal Access Surgery extrahepatic portal vein obstruction laparoscopic cholecystectomy portal cavernoma portal cavernoma cholangiopathy |
| title | Laparoscopic cholecystectomy in patients with portal cavernoma without portal vein decompression |
| title_full | Laparoscopic cholecystectomy in patients with portal cavernoma without portal vein decompression |
| title_fullStr | Laparoscopic cholecystectomy in patients with portal cavernoma without portal vein decompression |
| title_full_unstemmed | Laparoscopic cholecystectomy in patients with portal cavernoma without portal vein decompression |
| title_short | Laparoscopic cholecystectomy in patients with portal cavernoma without portal vein decompression |
| title_sort | laparoscopic cholecystectomy in patients with portal cavernoma without portal vein decompression |
| topic | extrahepatic portal vein obstruction laparoscopic cholecystectomy portal cavernoma portal cavernoma cholangiopathy |
| url | http://www.journalofmas.com/article.asp?issn=0972-9941;year=2021;volume=17;issue=3;spage=351;epage=355;aulast=Sasturkar |
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