Laparoscopic cholecystectomy in the densely scarred abdomen.

Extensive intra-abdominal adhesions are a possible contraindication to laparoscopic cholecystectomy and are known to occur after peritonitis because of perforated hollow viscus or multiple abdominal operations. Four such patients, who had undergone three or more previous abdominal operations, and had additional complicating factors, were successfully treated by laparoscopic cholecystectomy. An initial subxiphoid incision with blunt finger dissection was used to place the primary port. This approach achieves greater success and is safer than the traditional open umbilical dissection, because it avoids extensive lysis of small bowel and transverse colon adhesions from the anterior abdominal wall.