AVOIDING COMPLICATIONS DURING LAPAROSCOPI C CHOLECYSTECTOMY - DIFFUSEBLEEDING OUT OF THE LIVER PARENCHYMA

The inflammatory pericholecystic reaction to acute or subacute cholecy stitis results in the involvement in the inflammatory process of conne ctive tissue within the liver bed, with subsequent neovascularization. The inflamed wall of the gallbladder and the surrounding connective t issue also involved in the inflammatory process become fused together thus preventing dissection in this plane. As a result, the gallbladder affected by acute cholecystitis frequently has to be dissected direct ly out of the liver parenchyma. The resulting diffuse parenchymal blee ding proves difficult to control by cauterization. In addition, there is a danger of postoperative bile leakage occurring. Today, the use of fibrin sealing is accepted practice in the treatment of oozing haemor rhage from the resection surface of the liver following resective surg ery, and for the prevention of postoperative biliary fistulae. Using s pecial application systems, the two-component fibrin sealing can now a lso be employed under video-endoscopic control. Through direct applica tion of the adhesive to the parenchyma in the liver bed using a flexib le catheter, diffuse oozing bleeds can be effectively arrested. In add ition, coagulation-related parenchymal necroses associated with the de velopment of biliary fistulae can be avoided. The technique of video-e ndoscopic controlled fibrin sealing is an important method of preventi ng and controlling complications arising during video-endoscopic surge ry.