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Sunday, June 16, 2024
HomeHealth tipsSurgery Steps(Trans-Duodenal): Approcah for CBD Stones

(Trans-Duodenal): Approcah for CBD Stones


โ€ขRemove cbd stones by instrumentation (Randall stones forceps, scoops of several types and sizes, irrigation catheter, biliary Fogarty catheter) or extrinsic pressure by milking the stones to the upward #choledochotomy (Figs. 14.30and 14.31).
โ€ขDemonstrate ampullary patency using a small French catheter. If doubt about patency remains, use a Bakes No. 3 dilator very carefully to avoid false passage. Choledochoscopy may be helpful. Conduct repeated irrigation of the biliary ducts to remove small stones or sludge. If stones are impacted in the ampulla, papillotomy for their removal will be necessary. (Figs.14.32,14.34, and 14.35).
โ€ขCarry out duodenal kocherization. Insert balloon catheter all the way down through the ampulla. Place stay sutures of 4โ€“0 silk at the duodenal wall in the area of the palpable balloon. โ€ขPerform duodenotomy using electrocautery Perform a sphincterotomy between the 10 and 11 oโ€™clock positions to a depth of 2โ€“3 mm using electrocautery (Fig. 14.41).
โ€ข Approximate the ductal and duodenal mucosa with interrupted 5โ€“0 synthetic absorbable sutures (Figs. 14.41 and 14.42). Execute duodenorrhaphy in two layers. Place a T-tube into the common bile duct and insert a Jackson-Pratt drain.
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???: Surgical Anatomy and technique 5th ed 2021.


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