Background: In the current era, the laparoscopic procedure such as laparoscopic cholecystectomy, laparoscopic hepatobiliary surgery and other open procedures such as open cholecystectomy, biliary stricture surgery, are performed regularly throughout the world and extrahepatic biliary tract is one of the most common sites of the surgical procedures. The incidence of biliary tract injury by laparoscopic cholecystectomy has been found to be higher than open cholecystectomy. Apart from various other causes of biliary injuries aberrant anatomical course of extrahepatic biliary system is a well established fact of iatrogenic ductal injury. Thus, an adequate recognition and awareness of anatomical abnormalities of extra hepatic biliary tree with its vessel, can decrease the morbidity and mortality related to the surgery. Methods: Study was done in Department of Surgery, Gandhi Medical College and Hamidia Hospital Bhopal, India on 100 cases, during period of Aug 2014 to Nov 2015, and dissection was carried out in department of Forensic Medicine and Toxicology after taking permission from ethical committee. Results: In 100 cases of study 72 were male and 28 were female in which 16% male and 10.7% female showed variations in their anatomy. The most common variation which we observed in our study was short cystic duct in 8 cases, and second most common variations was cystic artery origin, from left hepatic artery in 3 cases and from proper hepatic artery in 1 case, other variations were floating gall bladder in 1 case, intrahepatic union of left hepatic duct and right hepatic duct in 3 cases, low insertion of cystic duct in 3 cases, high insertion of cystic duct to common hepatic duct in 1 case,and in one case cystic artery passing anterior to common hepatic duct. Conclusion: There was a significant variations seen in extrahepatic biliary apparatus and its related arterial supply in our study, and these variations observed could definintely be useful to hepatobiliary, laparoscopic surgeons and radiologist. And will further contribute to literature available on variations of extrahepatic biliary system.
Background: The aim of the study was to determine the best treatment modality for common bile duct stone become more challenging as large number of options available such as endoscopic, laparoscopic or open surgical methods, we need to choose specific therapy according to patient’s clinical conditions, and individual expertise.Methods: It is prospective study including 60 patient having common bile duct stone along with gall bladder stone, its different modality of management and its inference, conducted in Bhopal Memorial Hospital and Research Centre, Bhopal, during period of January 2017 to January 2020.Results: In 60 cases 41 patients undergoes to endoscopic retrograde cholangio pancreatography (ERCP) first, stone successfully removed in 34 patients and stent placed, one patients developed pancreatitis after ERCP, managed conservatively, In 6 patients retained stone after ERCP procedure, one patients developed surgical emphysema after procedure, managed with ICD and conservatively, and one patient had bleeding during sphincterotomy so its procedure abandoned and one of the patient failed to cannulate common bile duct (CBD). 21 patients undergo laparoscopic common bile duct explorations, 2 lap CBD exploration converted to open CBD exploration with cholecystectomy, due to adhesion at hepatocystic triangle. Five patients undergoes open CBD exploration, in one patient hepaticojejunostomy was done as patient was having CBD stone with stricture. No mortality during and after procedure.Conclusions: Management of CBD stone is depends upon individual expertise and available modality. If surgeons are expertise then lap CBD exploration with cholecystectomy without attempting to ERCP guide stone removal is best approach in majority of patients.
Background: In the current era of laparoscopic procedure, laparoscopic cholecystectomy are most commonly performed surgery all over the world. The biliary tract injury by laparoscopic cholecystectomy has been found to be higher than open cholecystectomy. So adequate recognition and awareness of anatomical abnormalities of encounter during laparoscopic cholecystectomy can decrease the morbidity and mortality related to surgery.Methods: It is prospective study including 200 patients based on intra-operative finding and their postoperative complication in Bhopal Memorial Hospital and research centre Bhopal, during period of Jan 2017 to Jan 2019.Results: In 200 cases 154 were Female and 46 were male. Mucocele of gallbladder in 22 cases, pyocele of gall-bladder in 7 cases. Gallbladder wall thickened and fibrosis in 13 cases. Gallbladder with duodenal fistula in 1case, gall bladder with colon and gall bladder with stomach fistula both in 1 case, and gall bladder with stomach fistula in 1 case. In one case there is absent gall bladder but patient havingCBD stone. Cystic artery cant separated from cystic duct and clipped along with cystic duct in 16 cases. In 3 cases there were gall bladder malignancy two were suspected intra-operatively and procedure abandoned other one after post lap cholecystectomy, confirm with biopsy report. Two cases develop post op incisional hernia. In 8 cases lap cholecystectomy converted into open cholecystectomy.Conclusions: This case series of laparoscopic cholecystectomy will help surgeons to be aware of such intra-operative finding and complication, so as to prevent undesirable outcome.
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