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General Surgery
Perspective on Biliary Diseases (A)
Built from Maingot's Abdominal Operations
What’s inside
7 sections · 63 slides
Overview
- Scope of this perspective
- Anatomy of the gallbladder and bile ducts
Laparoscopic cholecystectomy and bile duct injury
Where keyhole surgery helped, and where it did not
- Uptake of laparoscopic gallbladder removal
- Benefits of the laparoscopic approach
- 0.4–1.3%
- Consequences of a bile duct injury
- Operative views during laparoscopic cholecystectomy
- Learning curve and injury risk
- Anatomic variability of the biliary tree
- Methods used to reduce bile duct injury
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- Staying in the plane on the gallbladder wall
- Indications for converting to an open operation
- Patterns of bile duct injury
- Isolated right posterior duct injury
- Steps to identify an isolated duct injury
- Contrast study through a percutaneous drain
Stones in the common bile duct
Choosing between the endoscope, the surgeon and the scanner
- Choledocholithiasis and how it is usually handled
- Bile duct and pancreatic duct entering the duodenum
- Route the endoscope takes at ERCP
- 90–95%
- Endoscopic tools for extracting and breaking stones
- Endoscopic view of a stent at the duodenal papilla
- Noninvasive tests used before ERCP
- MRCP of stones in the gallbladder and bile duct
- ERCP cholangiogram of the bile duct
- Remaining role of ERCP and intraoperative cholangiography
- Choosing the first test for a suspected duct stone
- Stones found after the gallbladder has been removed
- Drainage operations for recurrent duct stones
- Intrahepatic stones and strictures
Choledochal cysts
Cystic widening of the bile duct, and its link with cancer
- Choledochal cysts and their types
- Patterns of cystic widening of the bile duct
- Management of type I and type IV cysts
- Management of type II and type III cysts
- Caroli's disease confined to one lobe
- Tests for cancer arising in a choledochal cyst
- Choledochal cyst types and their treatment
Bile leaks after cholecystectomy
Finding the source, draining it, and timing the repair
- Bile leak and biloma
- HIDA scan in a suspected bile leak
- HIDA result and the next investigation
- Injecting the subhepatic drain
- Timing of repair after drainage
- Transhepatic catheter and cholangiogram schedule
- Recurrent pyogenic cholangitis
- Drainage versus resection in recurrent pyogenic cholangitis
Gallbladder cancer and cholangiocarcinoma
Staging, incidental tumours and the limits of imaging
- Staging changes in gallbladder carcinoma
- Lymph node groups in gallbladder carcinoma
- Incidentally found gallbladder carcinoma
- Resected liver containing a tumour where the ducts meet
- CA19-9 as a marker in bile duct cancer
- Imaging limits in cholangiocarcinoma
- Percutaneous catheters before hilar resection
- Cholangiogram with a percutaneous catheter in place
Laparoscopic biliary procedures
What the keyhole route is worth today
- Routine versus selective intraoperative cholangiography
- Indications for a selective cholangiogram
- Training and gains from advanced laparoscopic biliary work
- Key points on preventing and finding injury
- Key points on stones, cysts and cancer
- References
- References (continued)
- References (continued)
- Maingot's Abdominal Operations, 12th Edition