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The rationale for this approach is that minute residual bile duct remnants may be present in the fibrous tissue of the porta hepatis and thus provide direct connection with the intrahepatic ductule system to allow bile drainage. [2] This procedure was developed in 1951 by Japanese biliary and hepatic pediatric surgeon Morio Kasai (1922–2008).
Access to the porta hepatis: The Kocher manoeuvre allows access to the porta hepatis, the gateway to the liver. By mobilizing the duodenum and pancreas, surgeons gain exposure to the structures in the hepatic portal area. Exposure of hepatoduodenal ligament: The procedure facilitates the dissection and exposure of the hepatoduodenal ligament.
The porta hepatis or transverse fissure of the liver is a short but deep fissure, about 5 cm long, extending transversely beneath the left portion of the right lobe of the liver, nearer its posterior surface than its anterior border.
The hepatoduodenal ligament is the portion of the lesser omentum extending between the porta hepatis of the liver and the superior part of the duodenum. [citation needed] Running inside it are the following structures collectively known as the portal triad: [1] hepatic artery proper; portal vein; common bile duct
Ultrasonography (US) is the first-line imaging technique for the diagnosis and follow-up of portal hypertension because it is non-invasive, low-cost and can be performed on-site. [ 17 ] A dilated portal vein (diameter of greater than 13 or 15 mm) is a sign of portal hypertension, with a sensitivity estimated at 12.5% or 40%. [ 18 ]
The recovery phase is characterized by resolution of the clinical symptoms of hepatitis with persistent elevations in liver lab values and potentially a persistently enlarged liver. [17] All cases of hepatitis A and E are expected to fully resolve after 1–2 months. [17] Most hepatitis B cases are also self-limiting and will resolve in 3–4 ...
A recent article published in the Journal of Surgery suggested that choledochal cysts could also be treated with single-incision laparoscopic hepaticojejunostomy with comparable results and less scarring. In cases of saccular type of cyst, excision and placement of T-shaped tube is done. [citation needed]
1. Bile ducts: 2. Intrahepatic bile ducts 3. Left and right hepatic ducts 4. Common hepatic duct 5. Cystic duct 6. Common bile duct 7. Ampulla of Vater 8. Major duodenal papilla 9.