Internal View at Choledochoscopy

18062022 Management of gallstones Dr Hamid

ERCP and Removal of Biliary Stent

complicated gallstones may present with dual problems of gallstones and bile duct stones with associated clinical syndromes in both... calculous cholangitis with bile duct stones will require ERCP and stone removal.. after the stones are removed, a biliary stent is frequently inserted to ensure bile drainage in any possible event of retained duct stones.. calculous cholecystitis will require laparoscopic cholecystectomy... following cholecystectomy, ERCP is repeated for the removal of the stent

Laparoscopic Cholecystectomy for Gangrenous and Perforated Gallbladder w...

Laparoscopic Cholecystectomy has been a gold standard for removal of a diseased gallbladder. Conversion to Open Cholecystectomy is indicated for gross gallbladder pathology that makes laparoscopic approach significantly hazardous. Gangrenous gallbladder, Perforated gall bladder and Empyema gallbladder are three such extreme pathologies that usually warrant a conversion. This video shows how successful laparoscopic cholecystectomy may still be successful in such hazardous conditions.

Laparoscopic Cholecystectomy - Aberrant Structures

Laparoscopic cholecystectomy is a common surgical procedure. Theoritically, there can be up to 25% of structures variations to the biliary tree. Surgeons will always have to keep in mind this brute anatomical fact in order to avoid biliary tree injury

Open Cholecystectomy for Gangrenous gallbladder

Although the gold standard for the removal of diseased gallbladder(especially gallstones-related cholecystitis) is Laparoscopic Cholecystectomy, I always tell patients that the chance of successfully completing the operation laparoscopically is only 90%, there is always about 10% chance of converting to open surgery.



The more severe the inflammation, the higher the chance of converting to open surgery.



The above patient suffered from Gangrenous Cholecystitis which failed laparoscopic attempt and had to be converted to open operation.

Open Cholecystectomy for Gangrenous gallbladder

Simultaneous Laparoscopic Cholecystectomy and Appendectomy

These are samples taken from the same patient during an operation. 

The most left is the removed Appendix. 

The middle is the removed Gallbladder. 

The most right is the soft gallstones removed from the gallbladder. 

This patient presented with one month history of right-sided abdominal pain in the middle. 

Typically, upper right-sided abdominal pain is caused by inflamed gallbladder(Acute Cholecystitis). 

Typically, lower right-sided abdominal pain is caused by inflamed appendix(Acute Appendicitis). 

So, the middle right abdominal pain give rise to the suspicion of simultaneously inflamed gallbladder and appendix(concomitant Acute Cholecystitis and Appendicitis). 

Since the gold standard operation to remove the gallbladder is by Laparoscopic Cholecystectomy, during the procedure, the appendix was also explored and confirmed to be inflamed. 

Laparoscopic Appendectomy was also attempted but due to adhesions and the retrocaecal location, dissection was hazardous and hence the procedure was converted to conventional Open Appendectomy.

Golds In Gut

In the midst of global economic slump,bordering on recession if not depression, any glitter that resembles that precious metal asset Gold is very attractive indeed.

Unfortunately,that gold-like structures above is a picture of multiple bile duct stones being extracted endoscopically during a procedure called Endoscopic Retrograde Cholangio-Pancreatography, or in short ERCP.

These stones originated in the Gallbladder.

Patients with symptomatic Gallbladder Stones(=Gallstones) who delay treatment in the form of Laparoscopic Cholecystectomy may be complicated by Bile Duct stones.

Usually,patients will experience excruciating abdominal pain in the area of the Upper Right abdominal region associated with Jaundice(Yellow Eyes) and sometimes Fever.

The treatment consist of 2 steps;

1.ERCP to remove the Bile Duct stones

2.Laparoscopic Cholecystectomy to remove the diseased gallbladder containing the original stones

The profile of Gallbladder stones

This is a typical specimen of an inflamed gallbladder packed with pigmented cholesterol gallstones removed from a patient who has been suffering from typical Acute Cholecystitis.

The typical symptoms of Acute Cholecystitis are;

- acute upper abdominal pain after taking foods rich in fats

- nausea

- vomiting

- bloated abdomen after eating

- fever

- sharp pain with breathing

The inflamed gallbladder above was removed by Laparoscopic Cholecystectomy.

Laparoscopic Cholecystectomy is the Gold Standard for the treatment of any diseased gallbladder