Vol.7, No 1, 2000 pp. 42 -45
UC 616.089
LAPAROSCOPIC CHOLECYSTECTOMY
ASSOCIATED WITH TREATEMENT OF HERNIA AND INCISIONAL HERNIA
Jecu Avram1, Marin Murariu1, Didina Toma1, Dana Bandu1 Sabin Pop1, Bogdan Totolici1, Mircea Tilincă1,
Nicolae Miculescu1, Rodica Avram2, Maria Mogoşeanu3
1First Surgical Clinic, University of Medicine and Pharmacy, str. Toplita Nr. 2a, Timişoara, Romania
22nd Medical Clinic ASCAR, University of Medicine and Pharmacy, Timişoara, Romania
3Clinic of Radiology, University of Medicine and Pharmacy, Timişoara, Romania
Summary. The association of cholelithiasis with hernia or incisional hernia poses a problem for the surgeon in evaluating whether laparoscopic cholecystectomy, a classic cholecystectomy followed by hernia or incisional hernia operation or a simultaneous operation is the preferred approach for this particular condition. The best choice is especially difficult, by the paucity of data on laparoscopic techniques in this situation.  In our clinic in the period 1.01.1994 - 15.01.1996 we performed 296 laparoscopic cholecystectomies ( L.C.) and we found at 5 cases the association of cholelithiasis with hernia: -1 case with giant infraumbilical incisional hernia; - 3 umbilical hernias , - 1 epigastric supraumbilical hernia. The 5 patients were females, age between 31 - 68. We choose the solution of simultaneous operation: L.C.  and operation for hernia.  Under general anesthesia we performed an incision at the level of the hernia, we isolated the peritoneal sack. Through a direct cutdown onto the peritoneum we controlled the presence of adherence and we prevented a visceral injury and as in an open laparoscopy we inserted laparoscopic port. A purse string suture is placed around the fascia and peritoneum in order to prevent excessive CO2 leak. We inserted the laparoscope and the other 3 additional ports. In the case of under-umbilical hernia we reduced the peritoneal sack with separate suture In the cases of umbilical hernia we introduced the first port through the umbilical sack. At the epigastric hernia we introduced the first port through the epigastric hernia and the 2-nd port infraumbilical. We performed normally the laparoscopic cholecystectomy and we finished by repairing the abdominal wall, closing the fascia defect. In incisional hernia we performed a parietal aloplasty with net. The postsurgery evolution was good in all the cases.
Key words: Laparoscopy, cholecystectomy, hernia
LAPAROSKOPSKA HOLECISTEKTOMIJA PRAĆENA OPERACIJOM HERNIJE
I INICIZIJALNE HERNIJE

Kratak sadržaj: Udružena holelitijaza sa hernijom ili inicizijalnom hernijom predstavlja hirurgu problem u proceni da li je laparoskopska holecistektomija sa klasičnom hernijom praćena operacijom hernije ili inicizijalnom hernijom poželjan pristup za pojedine slučajeve. Najbolji izbor je naročito otežan malobrojnim podacima o laparoskopskim tehnikama u ovakvoj situaciji. Na našoj klinici u periodu od 1.09.1994. do 15.1.1996. izvršili smo 296 laparoskopskih holecistektomija i otkrili u pet slučajeva udruženu holelitijazu, tri umbilikalne, jednu epigastričnu nadpupčanu herniju i jedan slučaj sa infraumbilikalnom incizijalnom hernijom. Svih pet pacijenata bilo je ženskog pola. Odlučili smo se za simultanu operaciju holelitijaze i operaciju hernije. Hirurški rez je urađen u nivou hernije, izvađena je peritonealna kesa. Operacioni tok bio je sledeći. Kroz direktan rez na peritoneumu kontrolisali smo prisustvo prijanjanja i sprečili visceralnu povredu i kao na otvorenoj laparoskopiji ubacili smo laparoskopsku cev. Na fascijama i peritoneumu uradili smo šav da bi se sprečio preterani gubitak CO2. Ubacili smo laparoskop i ostale tri cevi. U slučaju pupčane hernije, smanjili smo peritonealnu kesu odvojenim šavom. Kod epigastrične hernije ubacili smo jednu cev kroz epigastričnu herniju a drugu infraumbikalno. Normalno smo izveli laparoskopsku holecistektomiju i hiruršku intervenciju završili zašivanjem abdominalnog zida sanirajući fascijalni defekt. U prvoj inicijalnoj herniji izvršili smo parijentalnu aloplastiju sa mrežom. Postoperativni tok je bio uspešan u svim slučajevima.
Ključne reči: Laparoskopija, holecistektomija, hernija