Abstract
In this paper, experience with laparoscopic cholecystectomy successfully carried out in a patients with chronic cholecystitis with severe adhesion was reported. The patient was a 65-year-old man presented with a severe epigastralgia. Pre-operative examinations (ultrasonography, abdominal CT) revealed a severe cholecystitis with thicked wall and gallstones. Moreover it was suggested an existence of dense adhesion around to the gallbladder. After dissection of the omentum adhesed to the gallbladder, laparoscopic cholecystectomy from fundus downward (LCFD) was indicated in this particular case because a dense adhesion between the gallbladder neck and duodenum was noted. For performance of cholecystectomy, the use of ultrasonically powered aspirator was extremely effective to dissect the gallbladder from the gallbladder fossa. Moreover endoscopic linear cutter was useful in the cases whose gallbladder had to be dissected at its neck because the cystic duct was not clearly identified. Finally the use of LCFD technique was strongly advocated in the cases with severe cholecystitis to prevent bile duct injury.
