Treatment
Conservative 1
• Fluid and electrolytes
• Urine output monitoring
• Correction of coagulation defects
• Prevention of infection
• Prevention of hepatorenal syndrome
• Nutrition
Conservative 2
• Bile acid binding resins, Cholestyramine (4g) or
cholestipol (5g) disolved in wter or juice × TDS
• Individualized regime for replacement of vitamines
A, D, E and K as needed.
• Antihistamine for pruritus
• Naloxone or nalmefene has improved pruritus
• Discontinuation of medications that cause or
exacerbate cholestasis
Surgical Options
By Pass Surgeries
• Roux-en-y hepaticojejunostomy
• Roux-en-y Choledochojejunostomy
• Roux-en-y Cholecystojejunostomy
Choledochoduodenestomy
Whipple’s operation
Pylorus Preserving Pancreaticoduedenectomy
Choledochotomy + T-tube drainage
Transduodenal sphincterotomy and sphinteroplasty
Roux-en-Y Hepaticojejunostomy
Roux-en-Y Choledochojejunostomy
Cholecystojejunostomy
Whipple’s Operation
Pylorus Preserving Pancreaticoduedenectomy
Open Exploration of CBD
T- tube
ERCP with Sphincterotomy
Transcystic CBD Exploration
Indications for Open CBD Exploration
• Multiple stones > 5
• Stones > 1 cm
• Multiple intrahepatic stones
• Distal bile duct sticture
• Failure of ERCP
• Recurrence of CBDS after sphinterotomy
CBD Exploration- Surgical Options:
• CBD exploration with T-tube decompression
• Choledochoduodenostomy
• Transduodenal sphincterotomy and
sphinteroplasty
• Roux-en-Y choledochojejunostomy
Criteria for Irresectability
• Extra hepatic metastasis
• Extrahepatic organ invasion
• Peripheral hepatic metastasis remote from
primary tumor
• Major vascular involvement
Palliative Procedures
• Interventional Endoscopy: Endoscopic stenting
• Radiology: Chemo radiation, Intralumial
brachitherapy
• Photo Dynamic Therapy
• High intensity intraductal ultrasound
• Palliative surgery: Cholecystojejunostomy,
choledochojejunostomy, Hepatojejunostomy +/-
gasrtojejunostomy,
