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Cholecystectomy, IOC, CBDE, T-tube Choledocostomy
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My Operations 2005
My Operations 2004
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My Report Card 2004
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Medical Anecdotal Reports 2005
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How I Do It?

CHOLECYSTECTOMY, IOC, CBD EXPLORATION,T-TUBE  CHOLEDOCHOSTOMY

 

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        Supine with padding at the posterior right upper quadrant

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        Asepsis-antisepsis observed

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        Sterile field prepared

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        Oblique right subcostal incision, carried down to peritoneum

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        Intraoperative assessment

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        CHOLECYSTECTOMY (same procedure)

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        Perform transcystic intra-op cholangiogram

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        Perform Kocher maneuver (release the lateral and posterior attachments of the 2nd portion of duodenum)

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        Palpate the CBD, pancreas and duodenum

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        Site of choledochotomy identified and skeletonized

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        Traction suture placed laterally and medially using silk 4-0

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        Vertical incision is made between the sutures

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        Irrigation with saline done proximally and distally to flush the stones out

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        CBD stones removed using Randall forceps

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        No.3 Bakes dilator is passed in the distal CBD and the tip is visualized thru the anterior wall of the duodenum

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        T-tube is inserted with limbs cut short

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        Choledochotomy is closed around the T-tube

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        Saline is injected to Ttube to check for leaks

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        Completion cholangiogram done to confirm the absence of stones

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        Irrigation with NSS

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        Hemostasis done

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        Complete count

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        T-tube is brought out thru a separate stab wound

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        Layer by layer closure

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        Peritoneum and post. rectus sheath - continuos interlocking -Vicryl-0

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        Ant.rectus sheath and fascia - continuos interlocking -Vicryl-0

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        Skin closed subcuticularly using vicryl 4-0.

bulletDry Sterile Dressing

 

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Copyright 2004 Department of Surgery Ospital ng Maynila Medical Center
Last modified: 11/09/05