Caption: Figure 2: (a) ERCP with cholangiogram
with normal CBD and no residual stricture at its lower end.
In all fifteen LAERCP procedures, cholangiogram
findings were consistent with choledocholithiasis, and balloon-sweep clearance of the duct was successful.
The factors that increased the risk of a long hospital stay included patients with an ASA class 3, a history of previous acute cholecystitis, cholangitis, or pancreatitis, a history of cirrhosis, being on long-term anticoagulation with warfarin, having standard-pressure pneumoperitoneum (14mmHg), having been given metoclopramide as an intraoperative antiemetic drug, having an intraoperative cholangiogram
, having an operative time of more than 60 minutes, having an incidental perforation of the gallbladder, using an abdominal drain, PONV, an NRS pain score more than 3, a parenteral analgesia requirement of more than 2 doses, an oral analgesia requirement of more than 2 doses, complications, and private ward admission.
The "critical view of safety" and intraoperative cholangiogram
(IOC) are the most commonly used methods.
was done in patient of end-to-end anastomosis repair over T-tube on 14th postoperative day.
IR procedures performed on 19 paediatric patients post liver transplant from April 2011 to April 2014 IR procedures Number performed Biliary PTC only 4 PTC and external 3 biliary drain PTC and internal- 3 external biliary drain Conversion of 3 external biliary drain to internal- external drain Biopsy US-guided, 23 percutaneous liver biopsy Other Image-guided 15 drainage of intra-abdominal collections or bilomas Image-guided 24 drainage of pleural effusion Image-guided 3 drainage of ascites Exchange of drains 4 (all types) IR = interventional radiology; PTC = percutaneous transhepatic cholangiogram
; US = ultrasound.
Furthermore, the fact that no leak from the biliary system during ERCP and T-tube cholangiogram
was observed made this scenario even more complicated.
 was treated initially by endoscopic dilatation and stenting in repeated endoscopic sessions, with upgrading of the stent, until cure was obtained (after full dilatation of the stricture segment as evident by loss of the waist in the cholangiogram
Stone size and number and bile duct size were documented on the cholangiogram
was then performed to define stricture length and diameter (Figure 1).
Thus, in the literature both forms of management have been described; however, emphasis must be put on the importance of intra-operative cholangiogram
for determining the actual operative technique that is suitable for a particular patient.
Finally, the world's first disposable cholangiogram
forceps have arrived in New Zealand courtesy of Surgico.