Saturday, May 21, 2011

When to Excise CBD (Common Bile Duct) in cancer of gallbladder


Indications for the resection of the EHBD in all stages of disease include —
1.Tumors involving the EHBD  Preoperatively indicated by the presence of obstructive jaundice, in the absence of distant metastasis

2. Tumors/gross lymph nodal enlargement close to or involving the common hepatic duct or hilum

3.  Inflamed or a fatty hepatoduodenal ligament rendering nodal dissection difficult

4. Patients ndergoing re-resection (since postoperative inflammation makes differentiation of tumor and scar difficult).

5.Positive cystic duct margin on intraoperative frozen section

6.Patients with associated APBDJ or choledochal cyst— these patients are at an increased risk of further metachronous malignancies of the biliary tree and should hence undergo EHBD resection at the time of treatment of the gallbladder cancer

In case of need for associated vascular resection/ reconstruction

Tuesday, April 26, 2011

Asymptomatic Gastric Varices

Gastric varices occur due to Left sided Portal hypertension also known as Sinistrial hypertension. In patients who have not bled, conservative management is advocated because the chance of developing significant bleeding is 4-18%
Surgery for the same is carried out in patients who are
Uncompliant
Any other surgery
REd wale sign is positive (These cases are under high risk for bleeding)