Laparoscopic Cholecystectomy Optimization: Partial Incision of Falciform Hepatic Ligament

The aim of the investigation was to develop an optimization technique for laparoscopic cholecystectomy and the prevention of intraoperative complications.

Materials and Methods. Among 393 laparoscopic cholecystectomies performed in 2012, 6 cases had a minor intraoperative complication: liver capsule rupture in gallbladder traction. To prevent the complication, an original technique was developed: partial incision of falciform hepatic ligament. The technique was later used in laparoscopic gallbladder surgeries in 57 patients in 2013–2015.

Results. The survey carried out enabled to distinguish a characteristic group to suspect complication risk, or increased risk factors of liver capsule rupture. For prevention purposes, 57 of 1,055 patients underwent partial incision of falciform hepatic ligament. The technique enables to enhance the right lobe mobility that makes it possible to perform an adequate gallbladder traction and avoid liver capsule rupture, improve the imaging of Calot’s triangle elements in non-mobile gallbladder, in limited liver mobility, in gallbladder position anomalies and the attachment anomalies of falciform and round ligaments of the liver.

Conclusion. The suggested technique of falciform ligament incision enables to avoid complications in the form of liver capsule rupture in complex cases, to reduce traumatism, blood loss in laparoscopic cholecystectomy, to enhance the operation availability and safety.

1. Fedorov I.V., Sigal E.I., Odintsov V.V. Endoskopicheskaya khirurgiya [Endoscopic surgery]. Moscow: GEOTAR-MED; 2001; 351 p.
2. Dadvani S.A., Vetshev P.S., Shulutko A.M., Prudkov M.I. Zhelchnokamennaya bolezn’ [Cholelithiasis]. Moscow: Vidar-M; 2000; 139 p.
3. Timerbulatov M.V., Khafizov T.N., Senderovich E.I. Surgical correction of early postoperative complications after laparoscopic cholecystectomy. Endoskopicheskaya khirurgiya 2010; 16(1): 25–27.
4. Gallinger Yu.I., Karpenkova V.I. Laparoscopic cholecystectomy: the experience of 3165 operations. Endoskopicheskaya khirurgiya 2007; 13(2): 3–7.
5. Shamirzaev B.N., Achilov Sh.D. Reduction means of complications of laparoscopic cholecystectomy in patients with acute cholecystitis. Endoskopicheskaya khirurgiya 2009; 15(4): 18–21.
6. Gorpinyuk V.P., Fomov G.V., Zvyagintsev V.V. Sposob laparoskopicheskoy kholetsistektomii [Technique of laparoscopic cholecystectomy]. Patent MYu PMR 472. 2015.

Gorpinyuk V.P., Fomov G.V., Zvyagintsev V.V., Mukhin А.S. Laparoscopic Cholecystectomy Optimization: Partial Incision of Falciform Hepatic Ligament. Sovremennye tehnologii v medicine 2017; 9(2): 141, https://doi.org/10.17691/stm2017.9.2.17