Podcast
Questions and Answers
What are the potential long-term complications associated with spilled or retained gallstones?
What are the potential long-term complications associated with spilled or retained gallstones?
Abscess and fistula formation
What are some factors that increase the rate of conversion to an open procedure during laparoscopic cholecystectomy?
What are some factors that increase the rate of conversion to an open procedure during laparoscopic cholecystectomy?
Emergent cholecystectomy, male sex, age >60 years, obesity, severe GB inflammation, choledocholithiasis, and prior upper abdominal surgery
In which situations is open cholecystectomy typically performed?
In which situations is open cholecystectomy typically performed?
When patients have contraindications to LC, require conversion from LC, or are undergoing laparotomy for another operation
Why should conversion to an open operation during laparoscopic cholecystectomy not be viewed as a failure or complication?
Why should conversion to an open operation during laparoscopic cholecystectomy not be viewed as a failure or complication?
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What is the purpose of partial cholecystectomy in the setting of severe acute inflammation?
What is the purpose of partial cholecystectomy in the setting of severe acute inflammation?
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What conditions are associated with the development of benign strictures?
What conditions are associated with the development of benign strictures?
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What is the significance of primary sclerosing cholangitis in the context of benign strictures?
What is the significance of primary sclerosing cholangitis in the context of benign strictures?
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How does hepatic transplantation relate to the development of benign strictures?
How does hepatic transplantation relate to the development of benign strictures?
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What is the incidence of major bile duct injury associated with LC?
What is the incidence of major bile duct injury associated with LC?
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What is the importance of dissecting the triangle of Calot free of fat, fibrous, and areolar tissue?
What is the importance of dissecting the triangle of Calot free of fat, fibrous, and areolar tissue?
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What is the role of IOC in laparoscopic cholecystectomy?
What is the role of IOC in laparoscopic cholecystectomy?
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What is the commonest cause of biliary injury during laparoscopic cholecystectomy?
What is the commonest cause of biliary injury during laparoscopic cholecystectomy?
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What is the contraindication for laparoscopic cholecystectomy in young patients?
What is the contraindication for laparoscopic cholecystectomy in young patients?
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What is the boundary of the hepatocystic triangle?
What is the boundary of the hepatocystic triangle?
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What is the significance of the critical view of safety in laparoscopic cholecystectomy?
What is the significance of the critical view of safety in laparoscopic cholecystectomy?
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What is the risk of injury to other structures during laparoscopic cholecystectomy?
What is the risk of injury to other structures during laparoscopic cholecystectomy?
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What is the main cause of acute cholangitis, a potentially life-threatening bacterial infection of the biliary tree?
What is the main cause of acute cholangitis, a potentially life-threatening bacterial infection of the biliary tree?
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Why is it essential to pre-treat patients with antibiotics before ERCP in the presence of a stricture?
Why is it essential to pre-treat patients with antibiotics before ERCP in the presence of a stricture?
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What is Charcot's triad, and how common is it in patients presenting with acute cholangitis?
What is Charcot's triad, and how common is it in patients presenting with acute cholangitis?
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What is the primary event that incites gallstone pancreatitis?
What is the primary event that incites gallstone pancreatitis?
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What type of gallstones are more likely to cause gallstone pancreatitis?
What type of gallstones are more likely to cause gallstone pancreatitis?
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What is the name of the condition where gallstones pass through the cystic duct and into the distal CBD, causing pancreatic ductal obstruction?
What is the name of the condition where gallstones pass through the cystic duct and into the distal CBD, causing pancreatic ductal obstruction?
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What is the risk of not decompressing the bile duct, especially in the presence of a stricture?
What is the risk of not decompressing the bile duct, especially in the presence of a stricture?
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What is the significance of routine antibiotic pre-treatment before ERCP in patients with strictures?
What is the significance of routine antibiotic pre-treatment before ERCP in patients with strictures?
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Study Notes
Complications of Gallstones
- Spilled and retained gallstones can lead to infrequent but serious long-term complications such as abscess and fistula formation.
- Factors associated with an increased rate of conversion to an open procedure include emergent cholecystectomy, male sex, age >60 years, obesity, severe GB inflammation, choledocholithiasis, and prior upper abdominal surgery.
Open Cholecystectomy
- Open cholecystectomy is performed in patients who have contraindications to laparoscopic cholecystectomy (LC), who require conversion from LC, or who are undergoing laparotomy for another operation.
- Conversion to an open operation should never be viewed as a surgical failure or complication, but rather as a way to avoid potential injury to the patient.
- A partial cholecystectomy is advocated when the ductal and vascular structures in the triangle of Calot cannot be safely identified in the setting of severe acute inflammation.
Benign Strictures and Bile Duct Injuries
- Benign strictures occur in association with chronic pancreatitis, choledocholithiasis, primary sclerosing cholangitis (PSC), prior hepatic transplantation, trauma, or iatrogenic injury after instrumentation or surgery.
- Clinical presentation includes acute cholangitis, a potentially life-threatening bacterial infection of the biliary tree typically associated with obstruction of the ductal system.
Diagnosis of Acute Cholangitis
- Patients present with a spectrum of disease severity, ranging from subclinical illness to acute toxic cholangitis.
- Fever is present in >90% of patients, and Charcot triad (fever, jaundice, and right upper quadrant pain) is present in only 50-70% of patients.
Gallstones and Biliary Pancreatitis
- Biliary pancreatitis, synonymous with gallstone pancreatitis, is a form of acute pancreatitis caused by the passage of gallstones through the cystic duct and into the distal common bile duct (CBD) where they can obstruct the biliary and pancreatic ducts.
- Pancreatic ductal obstruction is felt to be the inciting event in gallstone pancreatitis.
Contraindications of Laparoscopic Cholecystectomy
- Concomitant diseases that prevent use of a general anesthetic.
- Patient's refusal of open cholecystectomy should urgent conversion be required.
Technique of Laparoscopic Cholecystectomy
- The surgeon must use a technique to provide conclusive identification of the cystic duct and artery in Calot's triangle and hepatocystic triangle.
- In the critical view of safety technique, the triangle of Calot is dissected free of fat, fibrous, and areolar tissue.
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Description
This quiz covers the complications and factors associated with open cholecystectomy, a surgical procedure to remove the gallbladder. It includes information on conversion to an open procedure and when it's necessary.
