Name of the Procedure:

Cholangiography and/or Pancreatography; Intraoperative, Radiological Supervision and Interpretation

Summary

Cholangiography and pancreatography are imaging procedures performed during surgery to visualize the bile ducts and pancreatic ducts respectively. They involve injecting a special dye into these ducts and using X-ray technology to see if there are any blockages, stones, or abnormalities.

Purpose

These procedures address conditions like bile duct obstruction, pancreatic duct abnormalities, gallstones, and tumors. The goal is to provide real-time imaging to guide surgical treatment, ensuring that any blockages or issues are accurately identified and managed during the operation.

Indications

• Symptoms like jaundice, unexplained abdominal pain, or pancreatitis.
• Suspicion of bile duct stones or leaks.
• Evaluation of pancreatic duct abnormalities.
• Assessment of ductal anatomy during hepatobiliary or pancreatic surgical procedures.

Preparation

• Patients usually need to fast for several hours before the surgery.
• Adjustment of medications, including blood thinners, as per doctor's instructions.
• Preoperative diagnostic tests, such as liver function tests and imaging studies, may be required.

Procedure Description

1. After the patient is anesthetized, a small incision is made in the abdomen to expose the bile ducts or pancreatic ducts.
2. A catheter is inserted into the ducts.
3. A contrast dye is injected through the catheter.
4. Real-time X-rays (fluoroscopy) are taken to visualize the ducts.
5. The surgeon interprets the X-ray images to identify any blockages, stones, or anatomical abnormalities.
6. The procedure can be adjusted as needed based on the imaging results.

Tools and equipment include catheters, contrast dye, and fluoroscopy imaging technology. General anesthesia is typically used to ensure the patient is unconscious and pain-free during surgery.

Duration

The procedure takes approximately 30 minutes to 1 hour, though this can vary based on the complexity of the case.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeons specialized in hepatobiliary or pancreatic surgery.
• Radiologists to provide imaging and interpretation.
• Anesthesiologists to administer and monitor anesthesia.
• Surgical nurses and technologists to assist with the procedure.

Risks and Complications

• Infection at the incision site.
• Allergic reaction to the contrast dye.
• Bleeding or injury to the bile or pancreatic ducts.
• Inflammation of the pancreas (pancreatitis).
• Very rarely, a perforation of the ducts.

Benefits

• Accurate identification and localization of ductal obstructions or abnormalities.
• Enhanced surgical outcomes through real-time imaging guidance.
• Immediate management of any discovered issues during surgery, reducing the need for additional procedures.

Recovery

• Post-procedure, patients are monitored in the recovery room until the effects of anesthesia wear off.
• Pain control is managed with medications.
• Patients may need to stay in the hospital for a few days, depending on the extent of surgery and their overall condition.
• Follow-up appointments are typically scheduled to monitor recovery and ensure no complications arise.

Alternatives

• Non-invasive imaging techniques such as MRCP (Magnetic Resonance Cholangiopancreatography) or ERCP (Endoscopic Retrograde Cholangiopancreatography) done preoperatively.
• Pros: Lower immediate risk compared to invasive procedures.
• Cons: May not provide real-time guidance during surgery and could necessitate additional procedures.

Patient Experience

Patients will be under general anesthesia and thus will not feel or remember the procedure itself. Postoperative pain and discomfort will be managed with medication, and patients will be given comprehensive instructions on pain management and post-surgical care. Any discomfort usually subsides within a few days, and patients can gradually return to their routine activities based on their surgeon’s advice.