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General Surgery
Perspective on Biliary Diseases (B)
Built from Maingot's Abdominal Operations
What’s inside
8 sections · 59 slides
Overview
- Scope of this perspective
- Topics covered
- Gallbladder and bile duct anatomy
Cholecystectomy and biliary injury
Why the common bile duct is still mistaken for the cystic duct
- Size of the bile duct injury problem
- Mechanism of major bile duct injury
- Origin of the critical view of safety
- Steps to the critical view of safety
- Attaining the critical view of safety
- Critical view of safety as an identification method
- Laparoscopic view of the gallbladder and its two structures
- Clipped cystic duct at cholecystectomy
- Evidence base for the critical view of safety
- Role of operative cholangiography
- Persistence with a difficult cholecystectomy
- Evidence on operating during acute cholecystitis
- Finishing versus stopping a difficult operation
- Gallstones inside opened gallbladders
- Bail-out operations for a difficult gallbladder
- Danger of the fundus-first takedown
- Culture of safety first
Vasculobiliary injury
When the artery is injured along with the bile duct
- Vasculobiliary injury defined
- Hepatic artery beside the bile duct
- Consequences of right hepatic artery injury
- Timing of repair after vasculobiliary injury
- Extreme vasculobiliary injury
Choledocholithiasis
Stones that have reached the main bile duct
- Stones in the common bile duct
- Bile duct exploration and ERCP compared
- Training and where treatment now happens
- Bile ducts outlined by dye during ERCP
Choledochal cysts
A rare problem with a serious knowledge gap
- Choledochal cysts and the knowledge gap
- Patterns of cystic dilatation of the bile duct
- Unanswered questions in choledochal cyst care
Gallbladder cancer
Suspecting it before the operation, not after
- Two presentations of gallbladder cancer
- Early gallbladder cancer in a patient with stones
- Value of preoperative suspicion
- Gallbladder polyps and cancer risk
- Porcelain gallbladder
- Gland-forming tumour of the gallbladder under the microscope
- Operative choice when cancer is suspected
- Selection bias in small case series
Cholangiocarcinoma
Cancer arising from the lining of the bile ducts
- Rising incidence of intrahepatic cholangiocarcinoma
- Gross types of cholangiocarcinoma
- Gross types and anatomic regions
- Behaviour of the periductal infiltrating type
- Prognosis of the intraductal growth type
- Preoperative diagnosis of cholangiocarcinoma
- Narrowed ducts at the hilum during ERCP
- Pale tumour at the confluence of the bile ducts
- Percutaneous drainage and tract recurrence
- Order of investigation for suspected hilar tumour
- Stenting the side to be preserved
- Portal vein embolisation before hemihepatectomy
- 25%
- Liver function after biliary obstruction
Take-home points
What this perspective asks surgeons to change
- Take-home points on cholecystectomy
- Take-home points on biliary tumours and cysts
- References
- References (continued)
- Maingot's Abdominal Operations, 12th Edition