Classic access
The incision provides a complete overview of Calot's triangle, ducts and surrounding organs: the elements are ligated with ligatures under the control of palpation, if in doubt, intraoperative cholangiography is performed, and the bladder bed is reliably treated. This access is chosen for fistulas of the bladder with the intestine, Mirizzi syndrome, cirrhosis with portal hypertension. Drainage 1–2 days; circuit anesthesia; activation from the first day. Histology included; control examination and removal of sutures - according to schedule.
Indications
- contraindications to pneumoperitoneum (severe cardiopulmonary pathology);
- massive adhesive process of the upper floor after operations;
- complicated forms: dense infiltrate, Mirizzi syndrome, fistulas;
- conversion in case of technical difficulties of laparoscopy (planned insurance).
Open surgery location today
Laparoscopy is the method of choice, but open cholecystectomy remains a necessary tool: for infiltrates and fistulas, direct tissue control is safer; for contraindications to gas in the abdomen, it is the only option. Mini access (4–6 cm) with a ring retractor combines the reliability of an open technique with less trauma: shorter hospitalization and recovery. All options are completed with the histology of the bladder; A two-day hospital stay is included according to the price list for open surgery.
