Operative procedures on the gallbladder and bile ducts

Diagnostics - collection of material for culture, application of contrast for cholecystocholangiography. waterproof with a tobacco suture into the cholecystostomy. It is practically not carried out today.
 * If it is necessary to perform the procedure as quickly as possible for the general condition of the patient.
 * Oblique or transrectal incision in the right subcostal region, or from upper median laparotomy.
 * we release the gallbladder from the bed towards the fundus (i.e. retrograde - we go from back to front).
 * we release the gallbladder from the bed towards the fundus (i.e. retrograde - we go from back to front).
 * we release the gallbladder from the bed towards the fundus (i.e. retrograde - we go from back to front).
 * we release the gallbladder from the bed towards the fundus (i.e. retrograde - we go from back to front).
 * we release the gallbladder from the bed towards the fundus (i.e. retrograde - we go from back to front).

Cholecystectomy
After removing the stones and verifying the patency of the cystic duct - we will install a stronger, fixed drain conducted by an artery.
 * Performed diagnostically or therapeutically.

Cholecystotomies
Antegrade procedure - we release the gallbladder in the opposite direction - from the fundus to the neck, until we finally ligate
 * We choose the antegrade or retrograde procedure:
 * We choose the antegrade or retrograde procedure:
 * We choose the antegrade or retrograde procedure:
 * We choose the antegrade or retrograde procedure:

Cholecystostomy
thumb|right|300px| Cholecystektomie Intraoperatively or laparoscopically. When it is necessary to drain the gallbladder externally (acute pancreatitis, severe inflammation). First performed in 1882 in Berlin, here for the first time by prof. Maydl (1891). to the same extent as the cystic duct, It is indicated less and less often.
 * Since removing stones from the gallbladder in cholelithiasis.

After cutting the peritoneum at the neck, we dissect the a. cystica, tie it, cross it, Retrograde procedure:
 * Sew the peritoneum above the bed, place a drain near the bed (drain bilealso from aberrant bile ducts, effusion, blood).

Puncture gallbladderu
Machine Translated by Google Diagnostic applications of ultrasound|sonograph]]. Between the ninth and twelfth day after the onset of the disease during one hospitalization. We leave a cannula in the cyst to diagnose the patency of the tract and papilla. In the stage - "at rest" on a "chilled" gallbladder. Within 72 h after the onset of the disease.
 * The mortality rate is low, not exceeding 1%.
 * So it must be well considered - there must be good equipment and personnel - x-ray is necessary, possibly intraoperative [[Ultrasound/
 * So it must be well considered - there must be good equipment and personnel - x-ray is necessary, possibly intraoperative [[Ultrasound/
 * No sooner than in 3 weeks during the next hospitalization.
 * This is a life-saving performance.
 * Prevents repeated exacerbations and repeated hospitalizations.
 * Prevents repeated exacerbations and repeated hospitalizations.
 * With signs of progression of inflammation, peritonitis.
 * Longitudinal incision of the choledochus.
 * With signs of progression of inflammation, peritonitis.
 * Longitudinal incision of the choledochus.
 * We prevent her from possible complications resulting from emergency surgery.

Deferred cholecystectomy
váljichch struktur v oblasti lig. hepatoduodenal (v. porta, a. hepatic, choledochus). surrounding organs and the operator would find it difficult to navigate; during this period it is operated only urgently.

Acute cholecystectomy
In addition, these are usually old people who are not ready for surgery.

Emergency cholecystectomy
The danger is with an acute exacerbation of chronic inflammation - the surrounding area is all overgrown and there is a risk of injury Between the 3rd and the 9th day, it is not worth operating, because the area around the gallbladder is affected by inflammation, covered with

Choledochotomie
Machine Translated by Google

Papillotomies vs papillosphincterotomies (PT + PST)
Although some bile will leak out through that hole, the adhesions that have formed around the T-drain will not allow it to get are difficult to treat. antrum stomach, intestinal loop). there. introduced choledochotomy probe.
 * If we cut more, we also cut the muscle - papillosphincterotomy.
 * Post-inflammatory or post-traumatic narrowing of the papilla.
 * The entire sphincter should never be crossed - reflux and cholangitis can then occur, which
 * In case of malignant obstruction of the lower part of the bile ducts, a temporary solution for icterus before a radical procedure.
 * We connect the Gallbladder or bile duct to the GIT (pars horizontalis duodeni,
 * We make the closure with an absorbable material - either primarily (simply sew it up) or, more often, we push a T-drain (Kehr's drainage) in
 * It is performed transduodenal, after releasing the duodenum as ERCP' (endoscopic retrograde cholangiopancreatography), on an
 * Drainage allows the outflow of bile after surgery, when there is spasm of the papilla, in a few days the drain is simply pulled out by pulling.
 * If we cut about 0.5 cm - papillotomy.

Anastomoses
Anastomoses of the gallbladder and bile ducts': It can be performed anywhere, most often supraduodenal (the choledochus has four sections - part intamural, part pancreatic, the part behind the duodenum and the part above the duodenum).
 * We can examine the bile ducts with a probe, forceps, spoon, endoscope
 * We can examine the bile ducts with a probe, forceps, spoon, endoscope

Divulsion (dilation) of the papilla
Can be expanded with probes of gradually increasing diameter. somewhere further... it will spontaneously close within 24 hours. Machine Translated by Google Intrahepatic Anastomoses - as an emergency leak, in case of hepatic hilum tumor. Technically demanding performance, frequent complications and necessary reoperations.
 * We sew the intestinal loop on the right or the stomach on the left to the wedge-shaped part of the edge of the liver.
 * We sew the intestinal loop on the right or the stomach on the left to the wedge-shaped part of the edge of the liver.

Links
Jaundice and then remove after about half a year.
 * cited = 5/5/2010
 * If necessary, resect the bile duct.
 * Instead of the stenosis, we cut it longitudinally and suture it transversely, we have to create an endoplasty under it, which we place transpapillary

Source
Hilar anastomoses': Cholangitida Machine Translated by Google
 * If the indication is a benign disease, we choose connection to a Roux anastomosis to prevent cholangitis.