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Patient care — surgical procedures

Bile duct stone extraction: Common bile duct exploration and stone extraction is typically problematic, tedious, and is accomplished via three surgical options:

 

photo 1. Open, which is an invasive procedure requiring a longer period of hospitalization and recovery. he objective of treatment is to remove the obstruction in the bile duct. Surgical removal of the gallbladder and the stones is one option.

In very complex or complicated cases, open cholecystectomy is usually recommended. An incision is made just below the ribs on the right side of the abdomen. The liver is moved to expose the gallbladder. The vessels and ducts to and from the gallbladder (cystic duct and artery) are cut and tied off, and the gallbladder is removed. The incision is closed.

 

2. Endoscopic Retrograde Cholangio-Pancreatography (ERCP), a second procedure that requires an endoscopic specialist, often not available in smaller hospitals. Patients who develop post ERCP pancreatitis can expect extended hospital stays.

Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. It is an x-ray examination of the bile ducts which is aided by a video endoscope. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x-rays.

ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP combines the use of x-rays and endoscopy, which is the use of a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x-rays.

photo ERCP is performed for diagnostic or therapeutic reasons. It is the gold standard for recurrent pancreatitis.

 

3. Laparoscopic Common Bile Duct Exploration (LCBDE) includes either transcystic or choledochotomy procedures and is a minimally invasive operation with the lowest associated morbidity & mortality. No second operation is required and the patient's diseased gall bladder is removed during the same procedure.

The common bile duct, which drains the digestive fluid (bile) from the liver to the small intestine (duodenum), is examined for bile blockages or for the presence of stones. A small flat tube may be left in for several days to drain out fluids if there is any inflammation or infection. In laparoscopic surgery, the abdomen is inflated with carbon dioxide to provide more room for the procedure. Through a small incision made at the navel, a laparoscope is inserted into the abdomen. Three small additional holes are made to allow the entry of surgical instruments. The gallbladder is located and the cystic duct and artery are cut and tied off. The gallbladder is removed. The incision is closed. Laparoscopic surgery has a lower rate of complications, a shorter hospital stay, and a better cosmetic results than the open procedure. However, in some cases the complexity of the situation requires use of the open technique.

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