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

 

Laparoscopic Cholecystectomy: 16

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

   
 

The infundibulum should be held away from the liver during these maneuvers and not directly upward. The latter maneuver puts the cystic duct in a direct line with the common (or right hepatic) duct and may lead to confusion as to where the cystic duct begins. If there is any question of anatomy at this point, a cholangiogram is performed. A short cystic duct leading into a normal or aberrant right hepatic duct is particularly hazardous (see biliary variation).     

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Laparoscopic Cholecystectomy: 17

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

   
 

Once the tip of the clamp has broken through and is visible, the clamp is opened behind the duct just enough to allow the placement of three clips. Excessive stretching can avulse the duct and injure underlying structures.       

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Laparoscopic Cholecystectomy: 18

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

   
 

The junction should be carefully examined to ensure that the "cystic duct" does not continue up behind the gallbladder into the liver. This situation may represent a short cystic duct or a Mirizzi's syndrome. In the latter, inflammation and stones erode a wide neck between the infundibulum and the common duct.      

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This page was last modified on 5/19/2000.