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Resezione della via biliare principale ed anastomosi epatico-digiunale

male patient of 73 years, with cancer of the common bile duct.
Supine position, left limb abducted by venous, arterial catheter, pulse oximetry digital. Central venous catheter and epidural catheter for analgesia. Heater air cushion.

1. engraving subcostal right extends to a brief portion of subcostal left.
2. section and ligation of the round ligament and placement of self-retaining retractor Omnitrack.
3. Section
4. mobilization of the falciform ligament of liver section with various liver ligaments and positioning of two flannels back to the liver to expose the organ.
5. Detachment of the gallbladder with bipolar scissors
6. intraoperative cholangiography, which shows the extent of the disease.
8. Isolation of the hepatic hilum and the bile duct, until it forks right and left hepatic duct with bipolar scissors and metal clips. Vesseloop finding with red and yellow elements hilar of the liver.
9. Isolation of biliary tract disease, which includes the section between the two branches of the liver and the region just distal to the insertion of the cystic duct.
10. positioning the proximal and distal colon cancer than with absorbable monofilament August 13
11. Chamber of right and left hepatic duct resection
12. sick of the way with a scalpel
13. extemporaneous histological examination of the margins of section
14. closure of the stump with choledochal string absorbable 3 / 0 suture and
15. conjunction of the two hepatic ducts with points absorbable monofilament 5 / 0 August 13.
16. Removal of 1 liver segment with bipolar irrigation
17. Definition and choice of the loop with which package jejunal anastomosis termino-lateral liver and fasting.
18. Packaging transmesocolica window for the passage of the loop that will go to the bilio-digestive anastomosis
19. section of the loop with GIA 80 e affondamento del moncone distale con riassorbibile monofilamento 4/0 ago 26
20. Confezionamento di anastomosi epatico-digiunale, su tutori tubolari in silastic fissati con punti riassorbibili, con riassorbibile monofilamento 4/0 ago 26, dopo avere asportato l'eccesso di mucosa dell'ansa digiunale con bisturi elettrico. La sutura viene effettuata a punti staccati, non annodati, fino a completamento del perimetro anastomotico. La legatura avviene al termine, mentre i punti vengono repertati con pinze Mosquito e separati con garze 10x10.
21. Al termine della anastomosi, vengono applicati punti di sutura per la pessi dell'ansa digiunale, in modo da evitare la trazione su di essa.
22. Confezionamento dell'anastomosi digiuno-digiunale end-to-side in a single layer with monofilament absorbable 4 / 0 August 26
23. wash the peritoneal cavity with copious amounts of Fis Sol.
24. Positioning drainage laminar split.
25. closure of the abdominal wall layers. Interesting

the final count: 40
flannels laparotomy
35 gauze needles
72
10x10 3 bladed scalpel
The surgery lasted about 5 hours.