Mr S Mitra, A 42 year male of Jodhpur Park Kolkata was admitted on 29th August 2017 under DR. Suddhasattwa Sen, Senior Consultant and Joint Director, Dept. of GI HPB (Gastrointestinal and hepatobiliary pancreatic surgery) in Medica Superspecialty Hospital, Kolkata, with complains of pain abdomen and dyspepsia and was diagnosed with Acute exacerbation of Cholelithiasis (Acute Gallbladder Stone Disease on chronic nature).
DR. Sen said that he had some very difficult comorbidities like full blown ankylosing spondylitis (a genetic condition giving rise to acquired complete spinal deformity and fixity and resulting in an individual being completely bent forward facing towards the ground) and also Chronic liver disease (Where liver condition is very poor and has more risks of bleeding, difficulty in operation and more chances of liver injury and liver failure and death). The patient required clearance through testing from various departments for safe surgery which was absolutely imperative to DR. Sen and Medica Hospitals (Patient safety first).
DR. Suddhasattwa Sen also said that Laparoscopic Gallbladder surgery is a norm nowadays, but it is extremely challenging in an Ankylosing spondylitis patient or in Chronic liver disease patient. So when both combinations are present, the surgery becomes technically extraordinarily difficult and challenging and morbid with high chance of failure or death.
Only 2/3 cases reported worldwide but they are either with special ports or without Chronic Liver disease.
This is probably the 1st case in the World to be reported regarding a successful bloodless / non transfusion Laparoscopic Cholecystectomy for acute on chronic GB stone in Chronic liver disease and Full blown Ankylosing Spondylitis.
Patient discharged in just 1 day post op on 31st August and now days he is fit without any post-operative problems.
USP of the case:
· A HORIZONTAL AXIS surgery was done in a VERTICAL (SITTING AND BENDING FORWARD) patient
· (NORMALLY IT WOULD BE JUST REVERSE)
· PATIENT WAS OPERATED IN SITTING POSTURE INCLUDING ANAESTHESIA IN SITTING UP POSITION AND NOT LYING DOWN.
The Liver was completely hidden below rib cage and upside turned where surgery was done From behind liver which is extremely difficult rather than from front which is usual and relatively easy. Liver condition was poor yet no problems happened. No blood transfusion was required in spite of liver condition expecting to have major blood loss. Unlike the case of 2016 from Japan where they did use SPECIAL ports for surgery and suggested normal port positions NOT possible for lap, We DID WITH NORMAL 4 PORT POSITIONS as USUAL.
The entire surgery required extremely high skill, endurance, planning and execution (especially since the patient is frail, was afraid and had cancelled surgery dates twice before and he is a bachelor living with elderly mother and is the only support of his mother in Kolkata).