Dedicated to care of patients with evidence based medicine

Large CBD stone

Lap CBD stone removal

CBD stones are primary when they originate in the CBD however if Gallbladder stone migrate into CBD it is called secondary CBD stone; CBD stones are mostly secondary; Patient present with pain abdomen/jaundice/fever; Treatment of secondary CBD stone is Gallbladder removal with removal of CBD stones; CBD stones are mostly removed by means of endoscopy (ERC), which can be done either one day before cholecystectomy or during cholecystectomy; Large CBD stones which can not be removed by means of endoscopy require surgical intervention; Laparoscopic CBD exploration is done and stones are removed, if CBD diameter is more than 2cm choledocho-duodenostomy is done otherwise it is closed primarily

Bile duct injury with biliary Fistula and stricture

Hepatico-jejunostomy

Most commonly bile duct injury occur during difficult cholecystectomy, Laparoscopy cholecystectomy should be converted into open whenever difficulty is faced because of adhesions or aberrant bile duct anatomy is suspected ; Intra-op whenever bile duct injury is suspected and experts are not available just put a drain and refer the patient to a higher centre, should be converted to open if there is vascular injury to control the bleeding; if the patient reach at tertiary centre within 48-72 hrs and is not in cholangitis then the aim is to look whether it is completely cut of CBD or not because at this time if it is completely cut then surgical intervention can be done; After 72 hrs repair is not done; MRCP can show biliary continuity when in doubt HIDA Scan can be done

Choledochal cyst

Cyst excision with Roux-en-Y Hepatico-jejunostomy