Biliary and Pancreatic Sphincterotomies for Sphincter of Oddi Dysfunction

This 43 year old woman has severe recurrent RUQ pain post cholecystectomy. Liver and pancreatic chemistries and duct size are normal, but pancreatic manometry is abnormal. The plan is to perform dual biliary and pancreatic sphincterotomy. The pancreatic duct is cannulated with a 3.9 French tip tr...iple lumen papillotome loaded with a 0.025 inch Jagwire. Contrast is injected to outline the course of the duct. The wire is passed to the tail. Notice the knuckling of the wire into the tail. This provides a safety loop, but is only safe in a small duct with use of a smaller caliber wire. Then with the wire securely in PD, papillotome is used to cannulate the bile duct. Placement of the wire in PD guarantees access for pancreatic stent placement, which is mandatory in these patients to reduce risk, it also facilitates difficult biliary cannulation. Here is the fluoroscopic view as the papillotome is passed deep into bile duct. This shows wires in the CBD and PD. Now a biliary sphincterotomy is performed, with the pancreatic guidewire in place beside the papillotome. The scope is pushed into a longer position to orient up the middle of the papilla. The sphincterotomy is done in very careful stepwise fashion to avoid perforation. Now the biliary wire is removed and the papillotome passed over the pancreatic wire for pancreatic sphincterotomy. The incision is aimed back up towards the biliary sphincterotomy to ensure the septum only is cut. Note the large pancreatic orifice. Last, a 4 French 9cm unflanged soft material pancreatic stent is placed. We always use single pigtail design to avoid inward migration of the stent. The long unflanged design allows spontaneous passage within a few weeks.

Axillary Cannulation: Antegrade Flow and Brain Protection

A video-animation presentation about sentinel lymph node biopsies for breast cancer diagnosis. 3D graphics are used to explain the process. Topics include the lymphatic system and the methods used. This video is part of the breast cancer education series produced by CancerQuest at Emory University

Ileocolectomy for Crohn's Disease

Duhamel's Operation for Chagasic Megacolon

Pilonidal disease with lateral extension - Follicle removal (Bascon's technique)

Follicle removal (Bascon's technique)

Pilonidal Cyst Removal by Laying Open Technique

Pilonidal disease with lateral extension. Follicle removal (Bascon's technique)

Resection of sigmoid colostomy prolapse

Resection of transverse colostomy prolapse

Transverse Colostomy Closure

Ileostomy Closure

Sigmoid Colostomy

Perineal rectosigmoidectomy

Delorme Operation for Rectal Prolapse

Lateral internal sphincterotomy

Fistulectomy procedure surgery

Fistulectomy surgery procedure video

Fistulotomy - Removal of Seton