Artery susceptible during cholecystectomy

- The artery most susceptible to injury during a cholecystectomy is the right hepatic artery, because of its proximity to the cystic artery and Calot's triangle.

source

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Choledochojejunostomy

- Anastomosis between common bile duct and jejunum.

source

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Hepaticojejunostomy

Anastomosis of hepatic ducts or common hepatic duct to jejunum

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IOC: IntraOperative Cholangiogram

- (done laparoscopically or open to rule out choledocholithiasis)

- It s a dye in the bile duct by way of the cystic duct with fluoro/x-ray

Indications for IOC

- jaundice

- hyperbilirubinemia

- gallstone pancreatitis (resolved)

- elevated alkaline phosphatase

- choledocholithiasis on ultrasound

- to define anatomy

soure

surgical recall, p.361

Cholecystectomy

- It is removal of the gallbladder laparoscopically or through a standard Kocher incision.

source

surgical recall p.358

Cholecystectomy: Kocher incision

A Kocher incision is a right subcostal incision.

source

surgical recall p.358

Sphincterotomy

- Cut through sphincter of Oddi to allow passage of gallstones from the common bile duct; most often done at ERCP; also known as papillotomy

source

surgical recall p.358

Complications: Postoperative biloma

A postoperative biloma after a lap chole is treated by:

- percutaneous drain bile collection

- ERCP with placement of biliary stent past leak (usually cystic duct remnant leak)

source

surgical recall, p.358

Complications: Common Bild Duct Injury

The treatment for major CBD injury after a lap chole is a choledochojejunostomy

source

surgical recall p.358

Laparoscopic Cholecystectomy: Complications

The possible complications of a lap chole are:

- common bile duct injury

- right hepatic duct/artery injury

- duct leak

- biloma (collection of bile)

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Cholecystectomy: Indications

Indications for cholecystectomy in asymptomatic patient

- sickle-cell disease

- calcified gallbladder (porcelain gallbladder)

- the patient is a child

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Laparoscopic Cholecystectomy: Procedure Steps

1. Dissection of peritoneum overlying the cystic duct and artery

2. Clipping of cystic artery and cannulation of cystic duct

3. Intraoperative cholangiogram, if necessary, then clip cystic duct

4. Division of cystic duct between clips

5. Dissection of gallbladder from the liver bed

6. Cauterization; irrigation; suction, to obtain hemostasis of the liver bed

7. Removal of the gallbladder through the umbilical trocar site

The gallbladder specimen should be opened in the operating room to look for gallbladder cancer.

source

surgical recall, p.363