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Cholecystectomy: How to remove the gallbladder from the abdominal wall

Well, this doesn’t happen often but as I was trying to remove the gallbladder from the abdominal wall (it had been placed in an endocatch bag), the bag ruptured. This was in the setting of a very large gallstone. I tried to pull out the bag but it wouldn’t come out. I then tried using a peon to spread the fascia open wider, and even used the cautery to extend the skin incision. The bag ultimately ruptured while I was trying to pull out the gallbladder.

My question to you guys is this: When you find yourself with a gallbladder that you cannot pull out of the abdominal wall, what techniques do you use so that you are able to pull it out, without rupturing the bag?

Another question I have for you guys is if you do have bile spillage on your port site, do you still close with running monocryl or do you staple the incision? What is your preference?

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