Page 33 - Journal of World Association of Laparoscopic Surgeons

RESEARCH ARTICLE
Laparoscopic Cholecystectomy at Cesarean Section

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Majid Mushtaque , Samina A Khanday , Junaid Sheikh , Arshad R Kema , Ibrahim R Guru , Tajamul N Malik
AbstrAct
Objective: To study the outcome of laparoscopic cholecystectomy at the time of cesarean section.
Materials and methods: Eight patients were subjected to laparoscopic cholecystectomy at the time of cesarean section. All of them were
diagnosed with cholelithiasis at the first antenatal scan. Laparoscopic cholecystectomy was performed by a standard technique, after assessing
the anatomy via the cesarean wound.
Results: Laparoscopic cholecystectomy was combined with lower segment cesarean section (LSCS) under general anesthesia in all patients.
Surgeries were completed in a mean operating time of 82 minutes. There were no intraoperative or major postoperative complications. No
extra antibiotics or analgesics doses were needed. Patients were discharged on the third and the fourth postoperative day.
Conclusion: A combination approach of laparoscopic cholecystectomy at the time of LSCS confers the benefits of minimal access for gallstone
disease apart from being safe, effective, and well accepted. With an additional small port site incision, single anesthesia, and single hospital stay,
the combined procedure confers valuable advantages in terms of time, hospital stay, cost, and convenience. It also prevents the possibility of
developing acute cholecystitis while the patient is waiting for cholecystectomy apart from avoiding the separation of mother from newborn
entailed by reoperation.
Keywords: Combined approach, Gallbladder disease, Laparoscopic cholecystectomy, Lower segment cesarean section, Pregnancy.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1348

IntroductIon 1 Department of Health and Family Welfare, Sub-District Hospital,
Lower segment cesarean section (LSCS) is one of the most Chadoora, Jammu and Kashmir, India
common operative procedures in women of reproductive age. 2 Department of Pathology, Government Medical College, Srinagar,
Gallstones are three times more common in women than men and India
cholecystectomy is the most common major operation worldwide. 3,4,6 Department of Health and Family Welfare, District Hospital,
While 2–4% of pregnant women are found to have gallstones by Badgam, Jammu and Kashmir, India
obstetric ultrasound, symptomatic cholelithiasis and cholecystitis 5 Department of Health, Guru Superspeciality Hospital, Jammu and
during pregnancy occur in only 5–10 of every 10,000 births. Most Kashmir, India
patients are effectively managed with conservative, nonoperative Corresponding Author: Majid Mushtaque, Department of Health and
therapy. In some patients, however, surgery is required for refractory Family Welfare, Sub-District Hospital, Chadoora, Jammu and Kashmir,
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symptoms or complications. The incidental finding of gallstones India, Phone: +91 9419010280, e-mail: drmajidmushtaque@gmail.com
has increased considerably as so many patients undergo ultrasound How to cite this article: Mushtaque M, Khanday SA, Sheikh J, et al.
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imaging of abdomen for a variety of conditions. It has been Laparoscopic Cholecystectomy at Cesarean Section. World J Lap Surg
shown that cholecystectomy for gallstones during laparotomy for 2019;12(1):25–28.
the unrelated condition may sometimes be appropriate because Source of support: Nil

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such patients are at a greater risk of developing symptoms. Many Conflict of interest: None

women undergoing gynecological surgery ask for cholecystectomy
to avoid future hospitalization and another operation. One Kashmir, India. A total of 20 pregnant women with concurrent
appropriate approach could be to perform combined cesarean gallstone disease were identified at their first antenatal sonography,
section and cholecystectomy in one sitting. Different varieties out of which, 12 were scheduled for laparoscopic cholecystectomy
of procedures have been done at the time of cesarean section, at the time of cesarean section. All the patients had gallstones.
including gynecological procedures, hernia repair, appendectomy, The selection criteria for the combined procedure were the
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and cholecystectomy. The combination of cholecystectomy same as that of the previous study by the authors. Patients who
with cesarean section is virtually undocumented outside of a case refused a combined procedure or had associated cardiovascular
8–10
report. The authors of the present article have reported the or pulmonary illnesses, acute cholecystitis in the third trimester,
feasibility and safety of combined LSCS and open cholecystectomy gallbladder mass, and symptoms or investigations suggestive of
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in a single sitting, and the present study is a further a step ahead common bile duct stones were not included in the study. In our
by approaching the patient with the laparoscopic technique for study group, one patient underwent open cholecystectomy for
gallbladder removal immediately after cesarean section. her intractable recurrent biliary colics in the second trimester of her
pregnancy and was excluded from the study. Three more patients
lost the antenatal follow-up. The remaining eight patients were
MAterIAls And Methods either managed conservatively for their symptomatic gallbladder
The study was conducted from July 2014 to August 2018 at Sopore disease or were asymptomatic during their pregnancy. Indications
Nursing Home and New City Hospital in Kashmir, Jammu and for cesarean section included cephalopelvic disproportion (CPD),
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