Download laparoscopic cholecystectomy and choledocholithotomy

LAPAROSCOPIC CHOLECYSTECTOMY
AND
CHOLEDOCHOLITHOTOMY
H
PRESENTED BY DR. NARSAIAH .B
M.S, FAIS, FICS
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HYDERABAD INSTITUTE OF
LAPAROENDOSCOPIC SURGERY

CONTACT
ADITYA HOSPITAL
OPP: ANDRA SARASWATI PARISHAD,
TILAK ROAD, ABIDS, HYD.
Ph: 4752988, 4754153.
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PATIENT SELECTION
 PATIENTS WITH SUSPECTED AND CONFIRMED
H
I
STONES (CBD) WERE TAKEN.
 ALL PATIENTS HAD DILATED CBD .
 STONES ARE LARGE (AND) OR MULTIPLE.
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S
 FAILED ERCP AND EXTRACTION OF STONES.
 ALL SUSPECTED CASES OF MALIGNANCY
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EXCLUDED FROM STUDY.
 FITNESS FOR GENERAL ANAESTHESIA.
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CENSUS
TOTAL NO. OF PATIENTS
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I
25

15
GENDER
L
YES 3
ERCP
S
YES 23
PRE OP.CBD STONES

NO 22
DIAGNOSIS DONE
US EXAMINATION
10
NO 2
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BIOCHEMICAL
L.C & C
INSTRUMENTATION
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ROUTINE VIDEO LAPAROSCOPIC
EQUIPMENT.
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30 DEGREE TELESCOPE.
RIGID URETROSCOPE,
CYSTOSCOPE, AND ACCESSORIES.
C-ARM FACILITY
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L.C & C
PROCEDURE
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 POSITION, PORTS, PROCEDURE LIKE LAP
CHOLECYSTECTOMY.
 ADDITION PORT IN EPIGASTRIUM.
 DISSECTION, ISOLATION AND LIGATION OF
CYSTIC DUCT.
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S
 PER OP CHOLANGIOGARAM PASSING
CATHETER THROUGH CYSTIC DUCT.
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 CHOLEDOCHOSCOPY VIA CYSTIC DUCTf OR
CHOLEDOCHOTOMY.
 T-TUBE INSERTION AND CLOSURE.
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OPERATION DETAILS
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OPERATION TIME 1 TO 3 HRS.
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BLOOD TRANSFUSION NIL.
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MORTALITY NIL.
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MORBIDITY NIL.
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NO RECURRENT OR RETAINED STONES ON
TWO YEAR FOLLOWUP.
ERCP + LAP.CHOLE
COMPARISON
TWO OR
MORE
SITTINGS
TWO
SPECIALIST
L.C & C
ONE
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H
ONE
I
TECHNICAL FAILURE
LESS OR
NIL
DIFFICULT
LARGE OR MULTIPLE
POSSIBLE
DIVIDED
SPHINCTOR OF ODDI
NOT DIVIDED
MORE
L
S
COMMON
CHOLANGITIS & PANCRETITIS
NIL
LC & C
STEPS
CBD STONES
H
SMALL AND MEDIUM
SIZE STONES
ICYSTIC DUCT
NARROW
CHOLIDOCHOTOMY
L
LARGE STONES,
MULTIPLE STONES, AND
BILIARYDUCT
CYSTIC DUCT WIDE
CHOLEDOCHOTOMY
S
STONE EXTRACTION
UNDER
DIRECT VISION
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CHOLEDOCHOSCOPY
d
AND
STONE EXTRACTION
L.C & C
CONCLUSION
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S
LAPAROSCOPIC
CHOLECYSTECTOMY
AND
CHOLEDOCHOLITHOTOMY
IS
BETTER ALTERNATIVE MANAGEMENT
OF C.B.D STONE OVER ERCP AND
CHOLECYSTECTOMY,
AND
WITH
GOOD EXPERTISE IN LAPAROSCOPIC
SURGERY IT EVOVLES AS STANDERD
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PROCEDURE.
THANK
YOU
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H
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