SAGES: rationale behind cholangiograpy

'perfect' chole
- complication does not occur
- symptoms are resolved after surgery
-

Rationale against IOC.
Stones infrequent or will pass
Increase or time and case cost
Possible cbd injury
Pancreatitis
Therefore selective IOC best

Rationale for IOC.
Cbd stones can cause trouble.
Allows lap cbde which saves $$ look for berci reference.
Prevents unnecessary cbde. ? Historical. Cbde was more common in open era.
As cbde exploration was higher
Ercpist may not want
Ercp may not be available
Decrease CBd injury
Interpretting cholangiograpy takes practice and can help understand biliary anatomy

Only one constant in cbd sigmoid curve where cbd form lhd.
Rhd an cd gets plugged in at various levels.
There can be subsegmental ducts in addition to rhd.

Special situations.
Surgical clips can cause stricturing.
Bilomas can cause compression and 'stricturing'

Duct of lushka does not exist sub vesicular ducts or segmental posterior ducts.

- Posted from iPhone