Below is a copy of the op report. An open Cholecystectomy was performed. I've never seen a nerve block given for post op pain for this procedure. This one has me stumped.
POSTOPERATIVE DIAGNOSIS: Cholecystitis.
PROCEDURE: An open cholecystectomy with intraoperative cholangiography.
DESCRIPTION OF FINDINGS: presents with symptomatic
cholecystitis. Nonoperative options were attempted, but they have all been
unsuccessful and now the patient wants to proceed with surgical management. The risks of surgery including bleeding, infection, inadvertent organ injury, and the risks associated with anesthesia were explained to the patient and informed consent was obtained.
DESCRIPTION OF PROCEDURE: The patient was taken to the Operating Room, placed into a supine position, and general endotracheal anesthesia was induced. Abdomen prepped and draped sterilely. Then I made a right upper quadrant incision, carried down through the skin and subcutaneous tissue.The subcutaneous tissue was bisected in 2 using cautery. Anterior rectus sheath was scored, rectus muscle was bisected in 2 with cautery achieving hemostasis. Posterior rectus sheath and peritoneum were opened the length incision taking care not to injure the viscera below.
Packs and retractors were used to expose the field. The gallbladder was
tense and distended. I decompressed the bilious fluid.
I then dissected into close triangle, identified the cystic artery. I suture
ligated it on its proximal side and then I clipped it on its distal side on
the gallbladder side and bisected in 2. I then took the gallbladder down in
a retrograde fashion, so was only tethered by the cystic duct. I tied the
cystic duct off with silk, made a small opening in it just distal to the tie,
inserted a cholangiogram catheter, and clipped in place. Intraoperative
fluoroscopic cholangiograms were obtained showed they were indeed within the cystic duct. Common hepatic, common bile, the radicals also contrast and dye went right into the duodenum with no evidence of an extrahepatic filling defect. Reexposure of gallbladder fossa was then performed as described above. I then doubly clamped the cystic duct on its side origin, with clips taking care not to injure the common hepatic or common bile duct and then I transected the cystic duct in 2, I removed the gallbladder from the operative field. Irrigated the wound until clear. Jackson-Pratt was placed into the Morison's pouch, brought out through a separate stab incision. All packs and retractors were removed. The posterior rectus sheath and peritoneum were closed with 0 PDS. Anterior rectus sheath was closed with Nurolon's, irrigated subcutaneous tissues. Skin was closed with clips. The catheter was sewn in with nylon. We then placed a local into the wound and 36 mL local and wound VAC was placed. The patient was awakened, extubated, and transferred to the Recovery Room in stable condition. Sponge and instrument count were correct in the case. Blood loss was minimal.
