Laparoscopic cholecystectomy after coronary artery bypass grafting using the right gastroepiploic artery: report of a case.
A laparoscopic cholecystectomy (LC) was successfully performed on a 61-year-old man who had undergone coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA). He complained of right hypochondralgia 20 days after CABG. Gallstones were diagnosed and a cholecystectomy was performed 9 months after CABG. Under general anesthesia, the operation was performed using a pneumoperitonium. When a laparoscope was inserted, the RGEA pedicle could be clearly recognized. The pedicle obstructed the operating field and made the working space narrower than usual. No ST changes on the electrocardiogram were seen during LC, especially during the initiation of pneumoperitonium, the insertion of the ports, or when retracting the gallbladder. The postoperative course was uneventful. To avoid complications, care should be taken not to stretch the RGEA pedicle during LC, and careful monitoring of the electrocardiogram is also necessary. It is difficult to view the operating field and the RGEA pedicle together. It is therefore better to insert another laparoscope for concomitant monitoring of the RGEA pedicle.
First Department of Surgery, Juntendo University, School of Medicine, Tokyo, Japan.
Kazuhiro
K
Sakamoto
Masayuki
M
Kitajima
Tsuyoshi
T
Okada
Shigeru
S
Shirota
Mitsuhiro
M
Matsuda
Suguru
S
Watabe
Yoshifumi
Y
Lee
Yuichi
Y
Tomiki
Shigeru
S
Kobayashi
Toshiki
T
Kamano
Masahiko
M
Tsurumaru
Kenji
K
Takazawa
D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods*; D004562:Electrocardiography; D024405:Gastroepiploic Artery / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*