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References in periodicals archive ?
We had to deviate from established methods of investigations like MRCP and few intraoperative steps (like choosing only transductal approach over transcystic approach, using intraoperative cholangiogram or laparoscopic ultrasound) due to unavailability and cost factor in our patients.
However, our results also suggested that while ASA class 3, intraoperative cholangiogram, operative time of more than 60 minutes, incidental perforation of the gallbladder, parenteral analgesia requirement of more than 2 doses, and PONV were significant risk factors in the univariable analysis, they were not independent risk factors for long hospital stays in multivariable analysis.
Routine intraoperative cholangiogram. Surgery, gynecology & obstetrics 1986;162:317-322.
Cholangiography methods were done by endoscopy (endoscopic retrograde cholangiopancreatography (ERCP)) for 346 patients (73.4%), percutaneous transhepatic cholangiogram (PTC) was done for 24 patients (5%), magnetic resonance cholangiopancreatography (MRCP) was done for 61 patients (13%), intraoperative cholangiogram was done in 24 cases (5%), and complementary tests, combination of all these tests, were done for 17 patients (3.6%).
The patient was admitted to the hospital and he was taken to the operating room where he underwent a laparoscopic cholecystectomy using the standard 4 port technique with intraoperative cholangiogram (Fig 1).
Thus, most of the abnormal intraoperative cholangiograms either were false-positives or identified stones that soon passed spontaneously.
Early on in the procedure, if there is any doubt as to the identification of the biliary structures, the surgeon may perform an intraoperative cholangiogram. This procedure may also be done if it is suspected that a stone has lodged in the common duct.
Experienced surgeons perform this procedure, including an intraoperative cholangiogram, in about 96 minutes.
Preoperative imaging sometimes may escape diagnosis, mostly diagnosed with intraoperative cholangiogram, ERCP, or MRCP.
[10] Maimonides Medical Center, "The use of fluorescent imaging for intraoperative cholangiogram during laparoscopic cholecystectomy," in, National Library of Medicine (US), Bethesda, Md, USA, 2011, show/NCT01424215.
The role of a routine intraoperative cholangiogram in delineating biliary anatomy and in turn preventing misidentification has been a subject of a long and intense debate amongst biliary surgeons but there is conflicting evidence on its value.
When the suspicion for CBDS is low and the gallbladder is present, it is suggested that patients undergo laparoscopic cholecystectomy with an intraoperative cholangiogram.
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