c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Biliary Pitfalls: 4

A D V E R T I S E M E N T

   

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If the critical view is obtained with a short cystic duct, options include clips if length is adequate, or top-down dissection.     

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Biliary Pitfalls: 5

A D V E R T I S E M E N T

   

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If clips are placed, there must be no tension on the cystic duct which could tent up the wall of the common duct. If the CBD wall is tented, the distal clip can partially or completely occlude the common duct lumen.     

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Biliary Pitfalls: 6

A D V E R T I S E M E N T

   
 

A large stone in the infundibulum can dilate and obliterate the cystic duct and erode into the common duct by pressure necrosis, causing common duct obstruction and jaundice. A top-down dissection may leave a cuff of infundibulum suitable for suture closure. If save control and patency of the common duct is not safely obtainable laparoscopically, open repair is indicated. A T-tube can be placed if there is adequate common duct continuity. If not a choledocho-jejunostomy is indicated.     

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This page was last modified on 8/11/2009.