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CBD Stent PPT.pptx

  1. Migration of CBD Stent Dr. Ramendranath Talukdar (Professor, Department of General Surgery) Dr. Amandeep Singh (PG 3rd year, Department of General Surgery)
  2. Have you heard people talk about “minimally invasive” surgery?
  3. Laparoscopic surgery is one kind. Doctors first used it for Gallbladder Surgery and gynecology operations.
  5. 62 year male • Pain in right hypochondrium since 2 months. • Dyspepsia and • Vomit on having fatty/oily food. • No significant past history.
  6. Clinical examination •Vitally normal •Tenderness over right hypochondrium region.
  7. Investigations • Bilirubin: 0.8 • SGOT: 138 • SGPT: 212 • ALP: 577 • INR: 1.1 • TSH: 2.82
  8. Ultrasound abdomen • Distended gall bladder with multiple focal signal void area suggestive of multiple calculi approx 7mm largest measuring with dilated CBD 11.5mm in diameter.
  9. MRCP •Dilated CBD of 11.5mm in diameter just proximal to site of insertion into D2 with CBD stone.
  10. • Patient had undergone ERCP with stenting on 15 June 2022 • Followed by laparoscopic cholecystectomy done on 27 July 2022
  12. On laparoscopic cholecystectomy tube like structure
  13. throughout from fundus to cystic duct
  14. Cutting of gall bladder at fundus
  15. Identification of stent
  16. Pulling of stent out of gall bladder
  17. Removal of stent
  18. Post-operative Gall Bladder Specimen with the Stent
  19. This case report is aimed at comparing the migration of CBD stent in gall bladder encountered during LC following ERCP.
  20. Migration/Misplacement of CBD Stents • About 8.4% • Proximal migration: 3.0% • Distal migration: 5.4% European Journal Gastro-enterology and Hepatology (July 2021)
  21. In conclusion, the optimum time to perform LC is within 3 days after ERCP.
  22. Different types of CBD stents
  23. The longer the interval between ERCP and LC, the higher are the chances of encountering complications and increased need for conversion as well as prolonged operating time and hospital stay.
  24. Though LC following ERCP is the gold standard for choledocholithiasis (seen in 10% patients of Gall Bladder stone) in the current general surgical practice, the operating surgeon should always be aware of our case difficulty encountered.
  25. Knowledge of these challenges will enable the surgeon in providing a safer and more favorable outcome in cholecystectomy.
  26. Thankyou……...............