By Arshad M. Malik
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Additional info for Advances in Laparoscopic Surgery
779-87. Kubota K. (2011). Recent advances and limitations of surgical treatment for pancreatic cancer. 5, pp. 225-8. Liu RC, Traverso LW. (2005). Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by computed tomography. 5, pp. 638–42. Mabrut JY, Fernandez-Cruz L, Azagra JS, et al. (2005). Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. 6, pp. 597–605. Makary MA. (2011). The advent of laparoscopic pancreatic surgery using the robot.
6 The diagnosis is suspected by noting the presence of air in the biliary tree associated with contracted gallbladder. The conditions where air is present within the biliary tree are infections by gas forming organisms, incompetent sphincter of Oddi, congenital anomalies, ERCP with sphincterotomy. Cholecystoduodenal, cholecystogastric and cholecystocolic are the common internal biliary fistulae. The common symptoms are pain, fever, diarrhea and jaundice. The most common cause for internal biliary fistulae is gallstones (90%) whereas; peptic ulcer, malignancy and trauma account for the rest 10% of the cases.
Low flow rate allows timely detection of a tension pneumothorax (increased ventilatory pressures and/or hypotension). Should this occur the pneumoperitoneum is immediately released and a size 32Fr chest drain is inserted on the most likely side. The procedure is then carried out open (Fabian). Diagnositc laparoscopy is achieved trough a 10mm umbilical port best inserted with an open technique. A 30degree laparoscope (5-10mm in diameter) allows optimal visualization of abdominal wall, diaphrams and liver/spleen dome.
Advances in Laparoscopic Surgery by Arshad M. Malik
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