مع الله
02-28-2008, 06:02 AM
http://www.bgsm.edu/surg-sci/atlas/cj1-titl.gif
INTRODUCTION
The majority of biliary bypass procedures are performed for palliation of unresectable malignant biliary obstruction. Surgical bypass is considered superior to endoscopic stenting when the patient is expected to survive for longer than 6 months. An endoscopic cholecystojejunostomy can be performed when a laparoscopic exploration reveals unresectable disease, or after chole static disease is confirmed by preoperative imaging. Choledochojejunostomy is another surgical option for biliary drainage. In comparison, cholecystojejunostomy is more a more feasible laparoscopic procedure. It is less invasive procedure, and associated with shorter operative time, postoperative convalescence and lower complication rates. To it's discredit, cholecystojejunostomy is not as durable as choledochojejunostomy and is not applicable to those patients with out a gallbladder or patent cystic duct. When combined with laparoscopic exploration and duodenal bypass (http://www.bgsm.edu/surg-sci/gastroj/gastroj.htm), chole static peripancreatic cancer is often staged and palliated with out an abdominal incision. This chapter describes the authors technical experience with and recommendations for performing laparoscopic cholecystojejunostomy.
Indications
1. Malignant obstruction
Contraindications
1. Malignant common bile duct stricture with in 1 cm. of common-duct-cystic duct junction.
2. Obstruction of cystic duct
3. Absent gallbladder
Special Equipment
A. Endoscopic GIA
B. 0-0 or 0-2 Nylon suture on a Keith needle
C. Endoscopic suturing instruments
Room Setup
http://www.bgsm.edu/surg-sci/atlas/cjsetup.gif
The surgeon and assistant can either stand on the same side or opposite sides of the table of the table.
The patient is supine with arms extended on arm boards.
Illustrations
http://www.bgsm.edu/surg-sci/atlas/cj2-titl.gif (http://www.bgsm.edu/surg-sci/atlas/cholej2.htm)
INTRODUCTION
The majority of biliary bypass procedures are performed for palliation of unresectable malignant biliary obstruction. Surgical bypass is considered superior to endoscopic stenting when the patient is expected to survive for longer than 6 months. An endoscopic cholecystojejunostomy can be performed when a laparoscopic exploration reveals unresectable disease, or after chole static disease is confirmed by preoperative imaging. Choledochojejunostomy is another surgical option for biliary drainage. In comparison, cholecystojejunostomy is more a more feasible laparoscopic procedure. It is less invasive procedure, and associated with shorter operative time, postoperative convalescence and lower complication rates. To it's discredit, cholecystojejunostomy is not as durable as choledochojejunostomy and is not applicable to those patients with out a gallbladder or patent cystic duct. When combined with laparoscopic exploration and duodenal bypass (http://www.bgsm.edu/surg-sci/gastroj/gastroj.htm), chole static peripancreatic cancer is often staged and palliated with out an abdominal incision. This chapter describes the authors technical experience with and recommendations for performing laparoscopic cholecystojejunostomy.
Indications
1. Malignant obstruction
Contraindications
1. Malignant common bile duct stricture with in 1 cm. of common-duct-cystic duct junction.
2. Obstruction of cystic duct
3. Absent gallbladder
Special Equipment
A. Endoscopic GIA
B. 0-0 or 0-2 Nylon suture on a Keith needle
C. Endoscopic suturing instruments
Room Setup
http://www.bgsm.edu/surg-sci/atlas/cjsetup.gif
The surgeon and assistant can either stand on the same side or opposite sides of the table of the table.
The patient is supine with arms extended on arm boards.
Illustrations
http://www.bgsm.edu/surg-sci/atlas/cj2-titl.gif (http://www.bgsm.edu/surg-sci/atlas/cholej2.htm)