Laparoscopic Drainage Debridement Cholecystectomy (LDDC) for Neglected gallbladder Empyema with Necrotic wall

The traditional treatment of gallbladder Empyema is cholecystostomy with drainage tube, and Cholecystectomy is to be done later on.

These live unedited videos demonstrate our technique of Laparoscopic Drainage of Neglected Empyema of the gallbladder combined with Debridement of the necrotic wall of the gallbladder through its cavity

The Patient is 65 years old, Diabetic, with history of liver cirrhosis, portal hypertension, calcular cholecystitis with recurrent acute attacks with history of previous ERCP for obstructive jaundice , there is history of Coronary artery bypass grafting one year ago .

The Patient presented with history of acute calcular cholecystitis for more than 3 weeks. The patient received antibiotics and conservative treatment with mild Improvement. Investigations were done , and abdominal US and CT were requested suggesting empyema of the gallbladder with pericholecystic collection.

Echocardiography was requested with cardiology consultation.

The Patient prepared for Laparoscopic surgery and as you see there was large mass, Cirrhotic liver with extensive adhesions and pericholecystic collections with empyema and necrosis of the gallbladder. Laparoscopic drainage was done after dissection to reach the collection around and inside the necrotic wall of the gallbladder. Debridement of the necrotic wall was also cautiously done from inside the gallbladder cavity through the necrotic fundus to avoid injury of surrounding adherent colon , adherent duodenum, bile duct and vascular structures.

At the end irrigation of the cavity was done with aspiration and insertion of drain tubes inside the cavity.

The Patient was markedly improved postoperatively.

Conclusion:

Laparoscopic drainage debridement cholecystectomy (LDDC) may be considered for cases with Neglected empyema of the gallbladder with necrosis of the wall of the gallbladder. Laparoscopic drainage debridement cholecystectomy is much better than cholecystostomy alone as the necrotic tissue is removed and the cavity is cleaned. The technique of Laparoscopic debridement cholecystectomy (LDC) may be partial , subtotal or near total according to the degree of necrotic wall that is removed.

This technique has the advantage of complete drainage comined with debridement of the necrotic wall of the gallbladder and may save the Patient from another Surgery for cholecystectomy later on which is needed in cases of percutaneous, Laparoscopic, or open cholecystostomy.

This technique should be done cautiously to achieve the best results and to avoid injury of surrounding structures.