Retroperitoneal necrotizing fasciitis: K. R. Woodburn et al. 10. 11.
12. 13.
Kingston D, Seal DV. Current hypotheses on synergistic microbial gangrene. Br J Surg 1990; 77: 260-4. Baillie FB, Linehan IP, Hadfield GJ, Gillet AP, Bailey BN. Infective cutaneous gangrene: urgency in diagnosis and treatment. Ann Plust Surg 1987; 19: 238-46. Fulminant necrotising fasciitis; a case report of retroperitoneal involvement. S Afr J Crit Cure 1987; 3: 12-14. Ledingham IMcA, Tehrani MA. Diagnosis, clinical course and
14. 15.
treatment ofacute dermal gangrene. Br JSurg 1975;62: 364-72. Scott SD, Dawes RFH, Tate JJT, Royle GT, Karran SJ. The practical management of Fournier’s gangrene. Ann R CON Surg Engl 1988; 70: 16-20. Asfar SK, Baraka A, Juma T, Ma’Rafie A, Aladeen T, A1 Sayer H. Necrotizing fasciitis. Br J Surg 1991; 78: 838-40.
Paper accepted 17 December 1991
Surgical workshop Br. J. Surg. 1992, Vol. 79, April, 344
Easy delivery of the gallbladder in laparoscopic cholecystectomy: a grooved director 1. M. Williams, B. 1. Rees and V. lvey University Hospital of Wales, Heath Park, Cardiff CF4 4XN, UK Correspondence to: Mr I . M. Williams Figure 1 Groooed direcfor with knife in situ
Within this unit over 300 laparoscopic cholecystectomies have been performed. One problematical area is actually removing the gallbladder through the abdominal incision. The gallbladder is usually brought out through the umbilical or the upper medial incision. After dissecting it from its bed, ensuring sound haemostasis and placing a suction drain into the subhepatic space, the surgeon grasps the gallbladder at its neck and brings it into the incision. The gallbladder may be full of biliary sludge and stones, and delivery is sometimes difficult owing to hold-up at the peritoneum (even though decompression may have been performed). To ease the problem an instrument has been devised to aid delivery of the gallbladder through the wound. It comprises a 15 x 1.5 cm piece of metal with a central groove (Figure 1 ). The instrument is introduced alongside the gallbladder into the
344
peritoneum. A knife is then slid down the groove to increase the space available by dividing the peritoneum. This manoeuvre aids delivery of the gallbladder without increasing the length of the skin wound. We have used this instrument in 18 operations when easy delivery has not been possible. The wounds are closed in the same way with Vicryl (Ethicon, Edinburgh, U K ) sutures on a J shaped needle taking a bite of peritoneum. There have been no complications after operation associated with the use of this instrument, and we have found it to be a time-saving and useful addition to the laparoscopic cholecystectomy tray. Paper accepted 11 November 1991
0007-1 323/92/040344-01
[c 1992 Butterworth-Heinemann
Ltd
12. 13.
Kingston D, Seal DV. Current hypotheses on synergistic microbial gangrene. Br J Surg 1990; 77: 260-4. Baillie FB, Linehan IP, Hadfield GJ, Gillet AP, Bailey BN. Infective cutaneous gangrene: urgency in diagnosis and treatment. Ann Plust Surg 1987; 19: 238-46. Fulminant necrotising fasciitis; a case report of retroperitoneal involvement. S Afr J Crit Cure 1987; 3: 12-14. Ledingham IMcA, Tehrani MA. Diagnosis, clinical course and
14. 15.
treatment ofacute dermal gangrene. Br JSurg 1975;62: 364-72. Scott SD, Dawes RFH, Tate JJT, Royle GT, Karran SJ. The practical management of Fournier’s gangrene. Ann R CON Surg Engl 1988; 70: 16-20. Asfar SK, Baraka A, Juma T, Ma’Rafie A, Aladeen T, A1 Sayer H. Necrotizing fasciitis. Br J Surg 1991; 78: 838-40.
Paper accepted 17 December 1991
Surgical workshop Br. J. Surg. 1992, Vol. 79, April, 344
Easy delivery of the gallbladder in laparoscopic cholecystectomy: a grooved director 1. M. Williams, B. 1. Rees and V. lvey University Hospital of Wales, Heath Park, Cardiff CF4 4XN, UK Correspondence to: Mr I . M. Williams Figure 1 Groooed direcfor with knife in situ
Within this unit over 300 laparoscopic cholecystectomies have been performed. One problematical area is actually removing the gallbladder through the abdominal incision. The gallbladder is usually brought out through the umbilical or the upper medial incision. After dissecting it from its bed, ensuring sound haemostasis and placing a suction drain into the subhepatic space, the surgeon grasps the gallbladder at its neck and brings it into the incision. The gallbladder may be full of biliary sludge and stones, and delivery is sometimes difficult owing to hold-up at the peritoneum (even though decompression may have been performed). To ease the problem an instrument has been devised to aid delivery of the gallbladder through the wound. It comprises a 15 x 1.5 cm piece of metal with a central groove (Figure 1 ). The instrument is introduced alongside the gallbladder into the
344
peritoneum. A knife is then slid down the groove to increase the space available by dividing the peritoneum. This manoeuvre aids delivery of the gallbladder without increasing the length of the skin wound. We have used this instrument in 18 operations when easy delivery has not been possible. The wounds are closed in the same way with Vicryl (Ethicon, Edinburgh, U K ) sutures on a J shaped needle taking a bite of peritoneum. There have been no complications after operation associated with the use of this instrument, and we have found it to be a time-saving and useful addition to the laparoscopic cholecystectomy tray. Paper accepted 11 November 1991
0007-1 323/92/040344-01
[c 1992 Butterworth-Heinemann
Ltd
