Postoperative Cholangitis
Monitoring postoperative general and local depends on the technique used.
In the event of a transcystic or choledochotomy closure primitive, it is considered that the certainty of the emptiness of the VBP was acquired, no exploration bladder is a priori justified, monitoring of liver suction drain in the absence of any checks bile leakage.
The presence of postoperative external biliary drain justify specific surveillance, the first thing to look at it is its speed:
- If the flow is low, check that it is not bent, its attachment to the skin is not too tight and there is no bile leak in the suction drain.
In doubt and if the clinical or laboratory evidence suggest it: Pain, fever, disruption of biological tests must hasten cholangiographic control to check that the drain is in place, moving the drain is an indication of further surgery.
- If the flow rate and significant above 600 or 700 ml/24h must evoke a barrier downstream and primarily a residual calculation, the diagnosis is made by cholangiography.
The importance of the leak can be quickly metabolic consequences (dehydration, leakage of sodium and bicarbonates) which are matched by contributions preventive oral or IV.
Cholangiography control by external biliary drainage is systematic, it shall be made 3-4 days after surgery, the absence of anomalies in the latter allows the clamping of the drain after 24 hours.
The patient will be kept for another 12 to 24 hours in surveillance to ensure tolerance: absence of biliary-type pain and fever.
The drain will be removed as an outpatient within 03 weeks.
In the event of a transcystic or choledochotomy closure primitive, it is considered that the certainty of the emptiness of the VBP was acquired, no exploration bladder is a priori justified, monitoring of liver suction drain in the absence of any checks bile leakage.
The presence of postoperative external biliary drain justify specific surveillance, the first thing to look at it is its speed:
- If the flow is low, check that it is not bent, its attachment to the skin is not too tight and there is no bile leak in the suction drain.
In doubt and if the clinical or laboratory evidence suggest it: Pain, fever, disruption of biological tests must hasten cholangiographic control to check that the drain is in place, moving the drain is an indication of further surgery.
- If the flow rate and significant above 600 or 700 ml/24h must evoke a barrier downstream and primarily a residual calculation, the diagnosis is made by cholangiography.
The importance of the leak can be quickly metabolic consequences (dehydration, leakage of sodium and bicarbonates) which are matched by contributions preventive oral or IV.
Cholangiography control by external biliary drainage is systematic, it shall be made 3-4 days after surgery, the absence of anomalies in the latter allows the clamping of the drain after 24 hours.
The patient will be kept for another 12 to 24 hours in surveillance to ensure tolerance: absence of biliary-type pain and fever.
The drain will be removed as an outpatient within 03 weeks.
09:09
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