Make your own free website on Tripod.com

 

Home Up

Cholecystectomy, IOC, CBDE, T-tube Choledocostomy
Home Up Table of Contents

 

Home
My Operations 2005
My Operations 2004
My Report Card 2005
My Report Card 2004
My Researches
Clinical Practice Guidelines
My Self-Evaluation
My Post-training Reflection
My Curriculum Vitae
Medical Anecdotal Reports 2005
Medical Anecdotal Reports 2004
Social Responsibility Program
How I Do It?

CHOLECYSTECTOMY, IOC, CBD EXPLORATION,T-TUBE  CHOLEDOCHOSTOMY

 

bullet

·        Supine with padding at the posterior right upper quadrant

bullet

·        Asepsis-antisepsis observed

bullet

·        Sterile field prepared

bullet

·        Oblique right subcostal incision, carried down to peritoneum

bullet

·        Intraoperative assessment

bullet

·        CHOLECYSTECTOMY (same procedure)

bullet

·        Perform transcystic intra-op cholangiogram

bullet

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

bullet

·        Palpate the CBD, pancreas and duodenum

bullet

·        Site of choledochotomy identified and skeletonized

bullet

·        Traction suture placed laterally and medially using silk 4-0

bullet

·        Vertical incision is made between the sutures

bullet

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

bullet

·        CBD stones removed using Randall forceps

bullet

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

bullet

·        T-tube is inserted with limbs cut short

bullet

·        Choledochotomy is closed around the T-tube

bullet

·        Saline is injected to T–tube to check for leaks

bullet

·        Completion cholangiogram done to confirm the absence of stones

bullet

·        Irrigation with NSS

bullet

·        Hemostasis done

bullet

·        Complete count

bullet

·        T-tube is brought out thru a separate stab wound

bullet

·        Layer by layer closure

bullet

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

bullet

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

bullet

·        Skin closed subcuticularly using vicryl 4-0.

bulletDry Sterile Dressing

 

Home ] Up ]

Send mail to rsmujermd@yahoo.com  with questions or comments about this web site.
Copyright © 2004 Department of Surgery Ospital ng Maynila Medical Center
Last modified: 11/09/05