title: Laparoscopic cholecystectomy in a patient with ankylosing spondylitis with severe spinal deformity.
abstract: Laparoscopic cholecystectomy is the current gold standard for the management of cholelithiasis. As experience with laparoscopic cholecystectomy has increased, contraindications to the procedure have started decreasing. Kyphoscoliosis with fixed rigidity is considered as a relative contraindication to laparoscopic surgery. Ankylosing spondylitis is a challenge to the anaesthesiologist because it is associated with difficult intubation, restrictive ventilatory defects, and frequent cardiac involvement. The benefits of laparoscopic surgery can be extended to this group of patients with severe kyphoscoliosis due to advances in anesthesia and surgical expertise. We report a case of laparoscopic cholecystectomy performed in a patient with severe ankylosing spondylitis with fixed rigidity of the cervical spine and marked thoracolumbar kyphosis with severe restrictive lung disease. The purpose of this report is to describe the difficulties encountered in anesthesia and operative difficulties due to altered body habitus in terms of patient positioning and surgical access.
authors.affiliation: Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India. chowbey1@vsnl.com
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Chowbey
authors.forename: Rashmi
authors.initials: R
authors.lastname: Panse
authors.forename: Rajesh
authors.initials: R
authors.lastname: Khullar
authors.forename: Anil
authors.initials: A
authors.lastname: Sharma
authors.forename: Vandana
authors.initials: V
authors.lastname: Soni
authors.forename: Manish
authors.initials: M
authors.lastname: Baijal
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D041761:Cholecystolithiasis / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D006801:Humans; D007738:Kyphosis / Q000453:epidemiology*; D008173:Lung Diseases, Obstructive / Q000453:epidemiology*; D011028:Pneumoperitoneum, Artificial; D013167:Spondylitis, Ankylosing / Q000453:epidemiology*