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[] (a) The procedure should now be converted to open. [] (b) This is a satisfactory study and the cholecystectomy can be continued. [] (c) The catheter should be repositioned by passing it further into the biliary tree and a repeat cholangiogram obtained. [] (d) A repeat cholangiogram should be obtained with rapid injection of a larger volume of contrast. [] (e) Don't Know
Question 2: A repeat cholangiogram was obtained, the proximal biliary tree was still not visualized. Figure 2 shows the opening through which the cholangiogram was obtained. At this time, the next step should be:
[] (a) Convert the procedure to open. [] (b) Attempt further laparoscopic dissection to identify the cystic duct - common bile duct junction. [] (c) Obtain an intraoperative laparoscopic ultrasound study. [] (d) A clip should be placed to occlude the opening and the operation continued. [] (e) Don't Know
Question 3: Steps in preventing the bile duct injury shown in the above figures include:
[] (a) Creation of a window between the infundibulum of the gallbladder and the liver bed to clearly identify the gallbladder - cystic duct junction in 360 degrees. [] (b) Proximal dissection of the cystic duct to clearly identify the common bile duct - cystic duct junction. [] (c) Adequate cephalic traction of the gallbladder fundus and lateral traction of the Hartmann's pouch. [] (d) A & C [] (e) All of the above [] (f) Don't Know
Question 4: The most common contributing factor in the occurrence of a bile duct injury during laparoscopic cholecystectomy is:
[] (a) The presence of anomalous anatomy. [] (b) Failure to adequately recognize the anatomy of the triangle of Calot. [] (c) The presence of acute inflammation. [] (d) The presence of chronic inflammation. [] (e) Failure to adequately retract the gallbladder. [] (f) Don't Know
Question 5: When a complete transection of the common bile duct is discovered at the initial operation, acceptable alternatives include:
[] (a) Primary repair over a T-tube, having the T-tube exit away from the repair site. [] (b) Primary repair over a T-tube, having the T-tube exit at the repair site. [] (c) A hepatico-jejunostomy. [] (d) Place a drain and transfer the patient to a center with an experienced biliary surgeon. [] (e) A, C & D [] (f) B, C & D [] (g) Don't Know
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