Choledocholithiasis (eBook)

B. Fernando Santos, MDAssistant Professor of SurgeryDepartment of SurgeryDartmouth College, Geisel School of MedicineVeterans Affairs Medical Center, White River Junction, VTWhite River Junction, VT Nathaniel J. Soper, MDLoyal and Edith Davis Professor and Chair of Surgery Northwestern Medicine Surgeon-in-Chief, Northwestern Memorial HospitalChicago, IL 

Historical Perspective on the Treatment of Choledocholithiasis: Lessons Learned and Techniques Prior to the Laparoscopic Era.- Current Understanding of Choledocholithiasis- Clinical Presentation and Pre-operative Evaluation.- Preoperative Decision-making Algorithm.- Intraoperative Ultrasound- Technique, Results, Pearls/Pitfalls, Rationale, and Benefits of Routine Use.- Intraoperative Cholangiography- Technique, Results, Pearls/Pitfalls, Rationale, and Benefits of Routine Use.- Laparoscopic Trans-cystic Exploration (Deciding who to Approach, Contraindications, Techniques- Cannulation, Dilation, Flouro-guided v. Choledochoscopy, Results, Complications, and Their Management.- Laparoscopic transcholedochal exploration (deciding who to approach, contraindications, technique of choledochotomy, instruments – catheters, scopes, etc., closure – primary v. t-tube v. internal drainage, results, complications and their management).- Stone fragmentation technologies and the approach to impacted stones (laser, mechanical lithotripsy, shock-wave, pneumatic and ultrasonic lithotriptors).- Adjuncts to common bile duct exploration (stents, drains, balloon dilation, antegrade sphincterotomy).- Open Common Bile Duct Exploration (indications/role in the modern era, technique, outcomes/complications).- Role of bilioenteric bypass in management of biliary stone disease (how to decide who needs this, technique, results/complications and management).- Endoscopic sphincterotomy for choledocholithiasis – preoperative v. postoperative, techniques, stone fragmentation for large stones, complications and management, outcomes, recent issues of infection with multi-drug resistant bacteria and implications).- Endoscopic ultrasound (EUS)- role in diagnosis and management of choledocholithiasis, transhepatic EUS approaches.- Laparoscopic-assisted ERCP (rendezvous procedures and transgastric ERCP).- Percutaneous techniques (transhepatic drainage).-  Overcoming Institutional and Logistical Barriers to LCBDE.