← All decks
The first 25 slides, exactly as they appear. The full deck has 59 content slides.
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