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José Miguel CABADA-LEE

Complejo Hospitalario Dr. Arnulfo Arias Madrid
Panama city, Panama
MD, FACS
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5.7K views
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Revisional surgery: analysis of technical errors during failed bile duct injury repair
This is the case of a 42-year-old woman who suffered from bile duct injury during an elective cholecystectomy. Immediate repair was performed by means of an open Roux-en-Y hepaticojejunostomy. Five months later, she developed cholangitis. Critical stenosis of the anastomosis was demonstrated with percutaneous transhepatic cholangiography. She was transferred to our unit to address the failed reconstruction. Many clues on why the initial attempt at reconstruction failed were found during our surgery. Discussion of these errors and how to avoid them is the main objective of the video. Secondary learning objectives are to highlight the principles of high quality bilioenteric anastomosis and demonstration of our standard technique for bile duct injury repair.
Surgical intervention
22 days ago
489 views
8 likes
1 comment
08:00
Revisional surgery: analysis of technical errors during failed bile duct injury repair
This is the case of a 42-year-old woman who suffered from bile duct injury during an elective cholecystectomy. Immediate repair was performed by means of an open Roux-en-Y hepaticojejunostomy. Five months later, she developed cholangitis. Critical stenosis of the anastomosis was demonstrated with percutaneous transhepatic cholangiography. She was transferred to our unit to address the failed reconstruction. Many clues on why the initial attempt at reconstruction failed were found during our surgery. Discussion of these errors and how to avoid them is the main objective of the video. Secondary learning objectives are to highlight the principles of high quality bilioenteric anastomosis and demonstration of our standard technique for bile duct injury repair.
Laparoscopic bile duct exploration with bile duct endoscopy and biliary bypass for recurrent biliary pancreatitis after cholecystectomy
This video shows the peculiar case of a 50-year-old male patient who underwent an open cholecystectomy for acute cholecystitis 12 years ago and he has been consulting for pancreatitis symptoms during the last seven years.
The patient reported that he had undergone ERCP twice after cholecystectomy because of bile duct stones and reportedly, complete bile duct clearance was achieved both times.
He presented to our facility with a new episode of mild pancreatitis.
No abnormalities were demonstrated in liver function tests. Amylase, GGT, and alkaline phosphatase values were normal.
Hepatobiliary ultrasound demonstrated a dilated common bile duct. MRCP (cholangio-MRI) showed several filling defects, particularly in the common bile duct and the left hepatic duct. CT-scan of the pancreas did not reveal abnormalities within the pancreatic parenchyma.
We decided to perform a bile duct exploration with endoscopic evaluation of the entire biliary tree and to perform a Roux-en-Y hepaticojejunostomy because of recurrent biliary pancreatitis after cholecystectomy.
Surgical intervention
2 years ago
1996 views
108 likes
0 comments
10:55
Laparoscopic bile duct exploration with bile duct endoscopy and biliary bypass for recurrent biliary pancreatitis after cholecystectomy
This video shows the peculiar case of a 50-year-old male patient who underwent an open cholecystectomy for acute cholecystitis 12 years ago and he has been consulting for pancreatitis symptoms during the last seven years.
The patient reported that he had undergone ERCP twice after cholecystectomy because of bile duct stones and reportedly, complete bile duct clearance was achieved both times.
He presented to our facility with a new episode of mild pancreatitis.
No abnormalities were demonstrated in liver function tests. Amylase, GGT, and alkaline phosphatase values were normal.
Hepatobiliary ultrasound demonstrated a dilated common bile duct. MRCP (cholangio-MRI) showed several filling defects, particularly in the common bile duct and the left hepatic duct. CT-scan of the pancreas did not reveal abnormalities within the pancreatic parenchyma.
We decided to perform a bile duct exploration with endoscopic evaluation of the entire biliary tree and to perform a Roux-en-Y hepaticojejunostomy because of recurrent biliary pancreatitis after cholecystectomy.
Laparoscopic pylorus-preserving pancreaticoduodenectomy for Gruber-Frantz tumor
This video demonstrates our technique for laparoscopic pylorus-preserving pancreaticoduodenectomy performed in a 15-year-old girl presenting with a history of episodic mild abdominal colic pain and right upper quadrant mass.
The preoperative diagnosis of a solid pseudo-papillary tumor (Gruber-Frantz tumor) was made, based on ultrasonography and computed tomography.
Laparoscopic resection was decided upon based on the fact that there were clearly defined surgical planes despite of the size of the mass. The usual sequence of steps for a pancreaticoduodenectomy was altered in this particular case because of tumor dimensions.
The procedure was carried out in 438 minutes without complications. There were no symptoms of delayed gastric emptying, and the patient was discharged on postoperative day 5. The microscopic study of the tumor confirmed a 10.5 by 9 by 5.5cm solid pseudo-papillary tumor of the pancreatic head.
Surgical intervention
3 years ago
833 views
24 likes
0 comments
09:00
Laparoscopic pylorus-preserving pancreaticoduodenectomy for Gruber-Frantz tumor
This video demonstrates our technique for laparoscopic pylorus-preserving pancreaticoduodenectomy performed in a 15-year-old girl presenting with a history of episodic mild abdominal colic pain and right upper quadrant mass.
The preoperative diagnosis of a solid pseudo-papillary tumor (Gruber-Frantz tumor) was made, based on ultrasonography and computed tomography.
Laparoscopic resection was decided upon based on the fact that there were clearly defined surgical planes despite of the size of the mass. The usual sequence of steps for a pancreaticoduodenectomy was altered in this particular case because of tumor dimensions.
The procedure was carried out in 438 minutes without complications. There were no symptoms of delayed gastric emptying, and the patient was discharged on postoperative day 5. The microscopic study of the tumor confirmed a 10.5 by 9 by 5.5cm solid pseudo-papillary tumor of the pancreatic head.