Laparoscopic Cholecystectomy and Previous Abdominal Surgery: A Safe Technique

Previous abdominal surgery has been cited as a contraindication to the performance of laparoscopic cholecystectomy. The present paper describes a technique whereby a Hasson cannula was introduced into the right iliac fossa by the open technique, using a method similar to an appendicectomy. The laparoscope was then introduced through this port and the safe introduction of other ports was achieved. Any adhesions were divided at this stage. The laparoscope was then moved to the umbilical port and a conventional laparoscopic cholecystectomy performed. In the series of six patients with upper or upper and lower abdominal scars, no patient suffered a complication or required a conversion to laparotomy. However, the operating time was increased from 75 to 105 min. This method involves open introduction of the primary trocar in an area devoid of adhesions. It was shown to be safe and with this method previous abdominal surgery should not be regarded as a contraindication.