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Saturday, February 5, 2011

CHOLECYSTECTOMY

The gall bladder is removed in cases of chronic cholecystitis, with or without the presence of gallstones. Disease of the gall bladder is common in women than in men.


TYPES OF INCISION
The most common incision used is the right upper para median incision. In certain cases (obese subjects, fro example, where good exposure is required), kocher's subcostal incision is used. This incision was employed more often in the past, before the introduction of muscle relaxing drugs in anaesthesia.

Kocher's subcostal incision:
The incision begins just below the xiphoid process and extends downwards and outwards to the tip of the 9th costal cartilage, 2.5 com below and parallel with the costal margin. All the abdominal muscles, including the lateral half of the rectus and its sheath, are divided in the same line. The 9th intercostal nerve is severed. Thus this incision produces a flaccid paralysis of certain of the fibres of the abdominal muscles, which predisposes to herniae.

Drainage
In a straight forward cholecystectomy some form of drainage is employed for 48-72 hours. Bile secretions are drained in to a Redivac vaccum bottle or a porto-vac suction unit.
When the common bile-duct is incised and explored (for the presence of an obstructing stone), a tube is used to drains into a bag attached to the patient's thigh and is usually retained for about 10 days.

EXERCISE THERAPY:
Primary exercises are Breathing, ankle/ foot and leg exercise. secondary exercise after post operative 4th day can do trunk exercise: lying; chest raising.
Getting up after cholecystectomy, when a drain is used for 48-72 hours, sitting in a chair for 10 - 20 minutes is usually allowed on the first post operative day. Walking is encouraged when the drainage is discontinued.
Discharge from ward. After straightforward cholecystectomy the patient is usually allowed to return home between the 7th and 10th postoperative day. When the common bile-duct is explored the patient is generally discharged from the ward between the 10th and 12th postoperative day.

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