2002, Number 4
Usefulness of transoperative video-assisted cholangiography, endoscopic aspects of the biliary tract
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ABSTRACTObjective: To demonstrate the diagnostic and therapeutic usefulness of transoperative video-assisted cholangioscopy in patients with suspected biliary obstruction, as well as to show the endoscopic aspects of the biliary tract.
Setting: Second level health care hospital.
Design: Observational, descriptive study.
Patients and methods: Nine patients were studied, their ages ranged from 40 to 60 years, of either sex. Patients were admitted to the emergency ward of the hospital from January to June 2001 with abdominal pain at the right hypochondrium, jaundice, hyperbilirubinemia, with right predominance. The ultrasound study revealed vesicular lithiasis, a choledochus larger than 12 mm in diameter, during surgery a greater than 1 cm diameter was found. A Storz videocholangioscope with an insertion tube of 3.5 mm was used. The following variables were analyzed: cause of the obstruction, characteristics of the biliary tract, and permeability to the duodenum.
Results: Eight videocholangioscopies and one with optic fiber were performed. In five patients it was performed through the choledochotomy and in four through the cystic conduct. Visualization was completed in eight cases; four patients presented secondary biliary lithiasis; purulent material in one patient and obstruction due to fibrin in another. Access to the duodenal lumen was achieved in five patients. A calculus was extracted in one patient using a Dormia basket; in the other three, resolution was achieved by irrigation through the cholangioscope. No Catell catheter was placed, allowing for primary closure of the choledochotomy.
Conclusion: Video-assisted cholangioscopy is a useful study in the presence of biliary tract obstruction that allows knowing the shape, track, and direction of the biliary tract, as well as the cause of the obstruction and offers the possibility of extracting the calculi.
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