Routine Nasobiliary Insertion During ERCP in High Risk Patients.
Routine Nasobiliary Insertion During ERCP in High Risk Patients.
110 patients with common bile duct (CBD) stones and had one or more anther preoperative
 predictors for high risk for difficult cholecystectomy admitted to departement of surgery of
 Minia university hospital for ERCP then laparoscopic cholecystectomy (LC). the patient
 divided into 2 equal group. in group 1, nasobiliary (NB) catheter was inserted during ERCP
 after CBD clearance. In group 2, only CBD clearance was done. In all patients LC was done
 within the same week of ERCP. Tans-nasobiliary Intraoperative cholangiography was done and
 methylene blue injected at the end of the procedure to detected any leak in NB group
110 patients with common bile duct (CBD) stones and had one or more anther preoperative
 predictors for high risk for difficult cholecystectomy as , age > 65 , male sex, obesity,
 acute cholecystitis, previous upper abdominal surgery, and certain ultrasonographic findings
 i.e. distended gall bladder (GB), thickened GB wall, pericholecystic fluid collection and
 impacted stone etc. these patients admitted to department of surgery of Minia university
 hospital for ERCP followed with laparoscopic cholecystectomy (LC). the patient divided into 2
 equal group. in group 1, nasobiliary (NB) catheter was inserted during ERCP to settle high up
 in the intrahepatic biliary tree after complete CBD clearance. In group 2, only CBD clearance
 was done. In all patients LC was done within the same week of ERCP. sequential, multiple,
 step after step, tans-nasobiliary Intraoperative cholangiography was done during every step
 in cholecystectomy especially during dissection of calot's triangle and just before clipping
 of supposed cystic duct (CD) to make sure that the structure supposed to be CD was not the
 CBD. after the end of procedure methylene blue is injected from the the NB to detected any
 leak and if present
Inclusion Criteria:

 -  patients with GB stone complicated with CBD stones

 -  accept to share in the study

 -  the presence of one or more preoperative predictors for high risk for difficult
 cholecystectomy

 -  patient fit for LC

 Exclusion Criteria:

 -  patients< 18 and >80

 -  unfit for surgery

 -  didn't accept to share in the study