Alumi Laparoscopic Discussion Board

Stump GB with retained stone
Discussion in 'All Categories' started by Dr Avinash Kumar Singh - Dec 28th, 2016 3:35 am.
Dr Avinash Kumar Singh
Dr Avinash Kumar Singh
Post lap chole 10 mm GB stump with 8 mm stone (MRCP) {no bile duct injury}, symptomatic (pain and jaundice). How and when to manage ?
re: Stump GB with retained stone by Dr R K Mishra - Dec 31st, 2016 12:15 am
#1
Dr R K Mishra
Dr R K Mishra
Dear Dr Singh

It would have been better if the detail of that patient is little more.

1. When surgery was performed: If surgery was performed many months before we should perform stump cholecystectomy. It is also called completion cholecystectomy. In this case conversion rate is quite high and any a time open surgery is recommended. You can see one of this video at https://www.youtube.com/watch?v=g8EzE6i7Oiw

2. If this situation is just postoperative: In my opinion immediate postoperative situation will retained stone with jaundice. Fist the patient should get ERCP and stent application. Once the jaundice will settle and wall thickness of GB return to normal and Liver function return to normal then again completion cholecystectomy should be performed.

With regard

Dr R K Mishra
re: Stump GB with retained stone by Dr Saimit Cabrera Davila - Dec 31st, 2016 3:59 pm
#2
Dr Saimit Cabrera Davila
Dr Saimit Cabrera Davila
Great apology, for my answer, I agree with a profesor and Master. The sphincterotomy should be performed because if a choledochotomy or a T-tube bypass was to be performed, without the sphincterotomy the procedure would have tension. And cause biliary leakage. Also add a CPR-MRI or cholagangiorresonance, see if you pass bile to the duodenum.

To my point of view there is much that should be taken into account. Since if the lito was giant? Had he fistulated, SIRS.why not an infundibulotomy per endoscopic? These are the cases that make one as a surgeon be very closely with the patient. Congratulation
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