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LAPAROSCOPIC SUBTOTAL CHOLECYSTECTOMY

LAPAROSCOPIC SUBTOTAL CHOLECYSTECTOMY

- SMALL PART OF GALL BLADDER LEFT CLOSE TO CBD
- DONE TO AVOID CBD INJURY
- USEFUL IN PATIENTS WITH FROZEN CALOT’S TRIANGLE
- ALL THE STONES FROM THE REMNANT GALL BLADDER SHOULD BE REMOVED
- MAY DEVELOP STONES IN THE REMNANT GALL BLADDER
- MAY REQUIRE REVISION CHOLECYSTECTOMY

GALL STONE PAIN AFTER LAPAROSCOPIC CHOLECYSTECTOMY

GALL STONE PAIN AFTER LAPAROSCOPIC CHOLECYSTECTOMY

- RETAINED STONE IN THE CYSTIC DUCT
- ABNORMAL LONG CYSTIC DUCT WITH STONE FORMATION AFTER SURGERY
- RESIDUAL STONE IN THE COMMON BILE DUCT
- SLIPPAGE OF GALL STONE INTO THE BILE DUCT DURING SURGERY
- DEVELOPMENT OF STONE IN THE RETAINED GALL BLADDER
- IMPACTED STONE IN THE AMPULLA OF VATER

LAPAROSCOPIC REVISION CHOLECYSTECTOMY

LAPAROSCOPIC REVISION CHOLECYSTECTOMY

- DONE FOR POST SUBTOTAL CHOLECYSTECTOMY WITH STONES
- RETAINED CYSTIC DUCT STONE LEADS TO CYSTIC DUCT DILATATION AND MAY REQUIRE SURGERY
- DENSE ADHESIONS CAN BE THERE
- LAPAROSCOPY IS BETTER OPTION
- PREOPERATIVE MRCP WILL BE USEFUL
- IN CASE OF TECHNICAL DIFFICULTY CONVERSION TO OPEN SURGERY IS IDEAL

LAPAROSCOPIC RADICAL CHOLECYSTECTOMY

LAPAROSCOPIC RADICAL CHOLECYSTECTOMY

- DONE IN CASE OF GALL BLADDER CANCER
- REMOVAL OF ABOUT 1CM OF LIVER AROUND THE GALL BLADDER
- LYMPHATICS AROUND THE BILIARY SYSTEM WILL BE REMOVED.
- THIS WILL GIVE BETTER CLEARENCE IN CASE OF GALL BLADDER CANCER
- BLEEDING FROM THE LIVE WILL BE CONTROLLED CAREFULLY
- ENDOBAG IS USED TO REMOVE THE SPECIMEN TO PREVENT THE SPILLAGE OF THE TUMOUR

GALL STONE DISEASE WITH BILE DUCT STONES (CHOLEDOCHOLITHIASIS)

GALL STONE DISEASE WITH BILE DUCT STONES (CHOLEDOCHOLITHIASIS)

- NEEDS TREATMENT FOR BOTH
- ERCP IS DONE FIRST TO TREAT CBD STONES
- IN CASE OF LARGE CBD STONES LITHOTRIPTER WILL BE USED TO CRUSH THE STONES
- LARGER CBD STONE CAN BE REMOVED THROUGH LAP CBD EXPLORATION
- AFTER ERCP, LAPAROSCOPIC CHOLECYSTECTOMY DONE TO REMOVE GALL BLADDER
- SOMETIME BOTH CAN BE DONE BY OPEN TECHNIQUE

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) WITH CBD STONE EXTRACTION FOLLOWED BY LAPAROSCOPIC CHOLECYTECTOMY (ERCP WITH LAPCHOLE)

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) WITH CBD STONE EXTRACTION FOLLOWED BY LAPAROSCOPIC CHOLECYTECTOMY (ERCP WITH LAPCHOLE)

- ERCP FOR CBD STONES
- BALLOON SWEEPING IS THE TECHNIQUE TO REMOVE STONE FROM CBD
- BALLOON SPHINCTEROPLASTY IS DONE TO REMOVE LARGE CBD STONE
- LITHOTRIPTER IS USED TO CRUSH THE CBD STONE BEFORE REMOVAL
- AFTER CLEARING THE CBD STONES GALL BLADDER SURGERY WILL BE PLANNED
- LAPAROSCOPIC CHOLECYSTECTOMY IS DONE FOR GALL BLADDER STONE.