CHOLECYSTECTOMY Preparation for operation

CHOLECYSTECTOMY Preparation for operation

• After appropriate history taking and assessment of the patient’s fitness for the procedure, routine laboratory investigations including a coagulation screen and liver function tests should tive be checked. The patient must sign a consent form to indicate that he or she is fully aware of the procedure being under - taken, the alternative options and the risks involved including - complications that may occur. Prophylactic antibiotics should be administered at the time of induction of anaesthesia. A /uni00A0 second-generation cephalosporin is appropriate . Subcuta - neous heparin and antiembolic stockings should be prescribed ( Summary box 71.4 ). The various factors identified as predictors of di ffi cult cho - lecystectomy are listed in Table 71.3 , and the risk factors f or the presence of CBD stones are listed in Table 71.4 . Preparation for cholecystectomy /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

Appropriate history taking (jaundice) and assessment Full blood count Renal and liver function tests Prothrombin time Chest radiograph and electrocardiogram (if medically indicated) Antibiotic prophylaxis, second-generation cephalosporin at the time of induction Deep vein thrombosis prophylaxis Informed consent: patient is aware of the procedure being undertaken, the alternative options and the risks involved TABLE 71.3 Risk factors of dif /f_i cult cholecystectomy. History Male gender, >65 years, interval between onset and presentation (>72–96 hours) in acute cholecystitis, previous multiple attacks, previous upper abdominal surgery, prior attempt at cholecystectomy (cholecystostomy) Physical examination Morbid obesity, high ASA score Laboratory tests Abnormal liver function tests Imaging (USG/CT/MRI–MRCP) Thick-walled gallbladder (>4–5 /uni00A0 mm) Contracted gallbladder Distended gallbladder with impacted stone in the neck Gangrenous gallbladder/gallbladder perforation Mirizzi’s syndrome/cholecystoenteric /f_i stula Cirrhosis/extrahepatic portal vein obstruction (portal cavernoma) with portal hypertension Intraoperative Shrunken gallbladder, liver edge retracted with /f_i ssure/depression/ puckering near the fundus, fatty/ /f_i rm cirrhotic liver (dif /f_i culty in retraction) ASA, American Society of Anesthesiologists; CT, computed tomography; MRCP , magnetic resonance cholangiopancreatography; MRI, magnetic resonance imaging; USG, ultrasonography.