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Laparoscopic Management of Biliary Stone Disease

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Laparoscopic Management of Biliary Stone Disease
Management Protocols
 

 

   Classifying the Biliary Stone Patient
Asymptomatic Cholelithiasis Incidental Finding on Sonogram
Acute Cholecystitis Cholelithiasis on Sonogram, clinical Cholecystitis diagnosis or Positive Pipida Scan
Symptomatic Cholelithiasis Positive Sonogram, normal Liver Function Tests
Cholelithiasis with Suspected Choledocholithiasis Abnormal Liver Function Tests (Serum Transaminases elevation or Bilirubin >3.0, gallstone pancreatitis)
Cholelithiasis with Choledocholithiasis CBD Stone on Sonogram, MR Cholangiography or Jaundice
Cholelithiasis with Resolving Gallstone Pancreatitis Pancreatitis on Sonogram, CT or MER Cholangiography or clinically, Documented High Serum Amylase and Lipase - WITH - Decreasing Serum Pancreatic Enzymes after initial attack
   Identifying Patients With Choledocholithiasis

MANAGEMENT PROTOCOLS FOR UNCOMPLICATED BILIARY STONE DISEASES

PROPOSED MANAGEMENT

Asymptomatic Cholelithiasis No Surgical Intervention
Asymptomatic Cholelithiasis in Diabetic Patients No Surgical Intervention
Symptomatic Cholelithiasis or Acute Cholecystitis LapChole
Symptomatic Cholelithiasis with Suspected Choledocholithiasis LapChole with Insertion of Cystic Duct Cannula with Cholangiography, if Choledocholithiasis, postop ERCP
Symptomatic Cholelithiasis with Choledocholithiasis LapChole with Insertion of Cystic Duct Cannula with Cholangiography, if Choledocholithiasis, postop ERCP
Cholelithiasis with Resolving Pancreatitis LapChole with Insertion of Cystic Duct Cannula with Cholangiography, if Choledocholithiasis, postop ERCP
Cholelithiasis with Unresolved Pancreatitis After acute phase subsides, MRI Cholangiography or ERC, if Choledocholithiasis ERCP followed by LapChole
Asymptomatic Gallbladder Polyps No Surgical Intervention
Symptomatic Gallbladder Polyps LapChole
Severe, Gangrenous Cholecystitis with Subhepatic Phlegmon LapChole, if not safely feasible, Anterior-subtotal LapChole
Post Cholecystectomy (Lap or open) Suspected Choledocholithiasis MR Cholangiogram or ERC
Post Cholecystectomy (Lap or open) Choledocholithiasis ERCP, if failure Laparoscopic Common Bile Duct Exploration.

 

   Management Protocol Diagram


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