Professor A. Cuschieri MD, ChM, FRCS (Eng),FRCS (Ed), G.'s Common Bile Duct Exploration: Intraoperative investigations PDF

By Professor A. Cuschieri MD, ChM, FRCS (Eng),FRCS (Ed), G. Berci MD, FACS (auth.)

ISBN-10: 9400960034

ISBN-13: 9789400960039

ISBN-10: 9400960050

ISBN-13: 9789400960053

2. Stone extraction through the T-tube 89 three. Endoscopic procedure 89 four. coaching for stone extraction ninety five. process ninety 6. effects ninety one 7. issues ninety one eight. dialogue ninety one Index of matters ninety nine bankruptcy 1 creation This e-book was once conceived as a descriptive atlas of foremost indication for universal bile duct ex­ regimen biliary surgical procedure i. e. , cholecystectomy and ploration. The cholangioscope permits a visible ex­ exploration of the typical bile duct. For the professional­ ploration of the biliary tree and allows the re­ ject the 2 authors labored jointly for one week moval of universal bile duct calculi and different as biopsy lower than direct visible con­ at Ninewells medical institution and clinical college, Dundee tactics such on a chain of sufferers with biliary tract sickness trol. either tactics were defined intimately particularly chosen for the workout. With the con­ with emphasis at the functional points in their use. despatched of the Tayside overall healthiness Board and the sufferers The period of blind bilary surgical procedure is over and the involved, the entire operations and peri-operative faster this message is acquired by means of all involved, techniques have been filmed through the photographic mem­ the higher the result of biliary surgical perform bers of the staff, Mr. and Mrs. Paz-Partlow. advert­ total. ditional case fabric has been acquired from It has no longer been our goal to supply a com­ Cedars Sinai scientific heart, Los Angeles.

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Extra info for Common Bile Duct Exploration: Intraoperative investigations in biliary tract surgery

Sample text

The tech- be long and the 60 mm scope is needed to visualize nique must be carried out under strict sterile condi- the ampulla (Figs. 1a-c). It is of utmost importtions. These requirements perhaps inhibited suc- ance to obtain an initial cholangiogram to see the cessful application until the recent revolution in drainage site and configuration of the distal duct, optical technology. Initial expectations of flexible because this will determine which scope should be fiber optics were thwarted because of the complex- employed (the shorter or the longer one) and what ity related to manipulation difficulties with re- type of difficulties can be anticipated because of the peated sterilization of these expensive instruments, long or tortuous drainage into the duodenum (Fig.

Interpreted as negative with no calculi. good sphincter function. and duodenal drainage. Because of the history (chills. jaundice. elevated liver function tests). the surgeon opened the duct and found cholangitis but no stones. Findings were supported by cholangioscopy. Fig. 26c. Completion T-tube cholangiogram after manipulations. Note the number of small irregular lucencies produced by the desquamation of debris during duct exploration. Fig. 26d. Completion cholangiogram of a different patient.

It can be corrected by a slow withdrawal or tilting of the scope slightly until, in case of the distal duct, the sphincter is seen, or, in case of the proximal insertion, the bifurcation. The best views are generally obtained during withdrawal of the scope followed by slow readvancement, but this time under visual control (Figs. 17a-b ). After satisfactory endoscopy of the distal duct, the scope is withdrawn, rotated 180 and reintroduced towards the hepatic ducts (Figs. 19a-b). Once the bifurcation is identified the scope is rotated to bring the right main orifice into view.

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Common Bile Duct Exploration: Intraoperative investigations in biliary tract surgery by Professor A. Cuschieri MD, ChM, FRCS (Eng),FRCS (Ed), G. Berci MD, FACS (auth.)


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