Hydro-dissection: An Effective Intra-Operative Technique for Difficult Laparoscopic Cholecystectomies: Hydro-dissection for Difficult Laparoscopic Cholecystectomies

Aun  Ali; Summaya  Saeed; Nadia  Shahid; Jabbar  Ahmed Qureshi; Mohammed  Ahmed; Ammara  Salam

doi:10.54393/pjhs.v3i06.338

Authors

Aun Ali Department of Surgery, Fazaia Ruth Pfau Medical College, PAF Base Faisal, Karachi, Pakistan
Summaya Saeed Department of Surgery, Dow International medical college / Dow University of Health Sciences (DUHS), Karachi, Pakistan
Nadia Shahid Ziauddin University Hospital, Karachi, Pakistan
Jabbar Ahmed Qureshi Department of Pharmacology, Ziauddin Medical College, Ziauddin University, Karachi, Pakistan
Mohammed Ahmed Department of Surgery, Fazaia Ruth Pfau Medical College, PAF Base Faisal, Karachi, Pakistan
Ammara Salam Department of Surgery, Fazaia Ruth Pfau Medical College, PAF Base Faisal, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v3i06.338

Keywords:

Cholecystectomies, Laparoscopic, Hydrodissection

Abstract

Hydrodissection, a technique used to treat nerve entrapments, involves injecting an anaesthetic, saline, or 5% dextrose in water to separate the nerve from the surrounding tissue. Objectives: To assess the efficacy of this technique in all patients undergoing difficult laparoscopic cholecystectomy in terms of operative time, haemorrhage, and intra-operative complications. Methods: A multicenter observational study was conducted at the department of surgery, PAF Faisal Hospital and Anis Bantva Trust Hospital Karachi. A total of 219 patients were included in this study who underwent laparoscopic cholecystectomy for symptomatic gall stones, with age ranging from 18-70 years, with intra-operative Cuschieri classification >1, using a non-probability sampling method. Results: This study included 219 patients from hospital records categorized as per intra-operative difficulty grading of Cuschieri from grade II-IV. The mean age of patients was 40.46 ±12.50 years, with an average duration of symptoms of 16.95 ± 8.73 days. There were 160 (73.1%) males and 59 (26.9%) females. About two-thirds of patients were admitted through the emergency department. The pre-operative and intraoperative diagnosis of patients was symptomatic cholelithiasis 76 (34.7%), acute on chronic cholecystitis (27.9%), chronic cholecystitis 57 (26.0%), empyema and mucocele gallbladder 11 (5%) each, and Gangrenous gallbladder 3 (1.4%) were recorded. Conclusion: This study showed a clear association of intra-operative complicated anatomy during laparoscopic cholecystectomy to its conversion to open cholecystectomy. Techniques of dissection are of significant importance to minimize injuries to vital structures

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