Gallbladder and Biliary Tract Surgery
Gallbladder stones are an extremely common disorder and are usually asymptomatic. Some patients experience biliary colic, an intermittent and often severe pain in the epigastrium or right upper quadrant, and at times between the scapula because of temporary obstruction of the cystic duct with a gallstone. If the cystic duct obstruction persists, the gallbladder becomes inflamed and the patient develops cholecystitis, an acute inflammation and infection of the gallbladder. The vast majority of patients with gallstones are asymptomatic.
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Some common ailments of gallbladder and bile duct are as follows:
- Gallstones are formed when bile salts become hard particles and create blockage.
- Cholecystitis is an acute and chronic inflammation.
- Acute cholecystitis could be the result of tumors and other illnesses.
- Chronic cholecystitis is caused due to shrinkage of the gallbladder due to repeated acute cholecystitis and loses its functionality.
- Choledocholithiasis occurs when the gallstones are lodged in the bile ducts or the neck of the gallbladder.
- Acalculous gallbladder disease is also called biliary kinesia which occurs due to the absence of gallstones.
- Primary Sclerosing cholangitis is scarring, inflammation and damage to the bile ducts.
- Gallbladder cancer spreads from the inner walls of the gallbladder to other organs.
- Gallbladder polyps are harmless growths or lesions on the gallbladder.
- Gangrene of the gallbladder occurs when there is improper or inadequate blood flow and the gallbladder does not function.
- Abscess of the gallbladder occurs when the area has pus formation and is inflamed.
- Bile duct obstruction is blockage of bile ducts due to gallstones.
- Bile reflux when fluid in the liver called bile backs up into the stomach and esophagus.
- Primary biliary cirrhosis occurs when small bile ducts in the liver are damaged.
- Laparoscopic cholecystectomy : In this procedure the gallbladder is removed by minimally invasive surgical techniques. The procedure is done under general anesthesia. Four small incisions are made in and around the umbilicus, which are called laparoscopic ports. Thin, long tubes or laparoscopes are inserted through these incisions which magnifies the view of the area. Surgical instruments are used to carefully separate the gallbladder from the liver and the bile duct and extract it through one of the ports.
- Laparoscopic common bile duct exploration : This procedure is commonly used in the treatment of choledocholithiasis and can be done percutaneously, laparoscopically or endoscopically. The approach is the same as laparoscopic cholecystectomy. Four ports are opened and a very small opening is made in the cystic duct where the gallbladder connects to the bile duct. Cholangiography is performed with the insertion of a thin tube. A balloon or a tiny basket is used to retrieve the stones from the duct.
- Laparoscopic bile duct bypass : The drainage of bile into the intestine is blocked due to stricture of the bile duct. The bile then accumulates in the blood and causes jaundice. Bile duct surgeries are very complex and difficult. Since the bile duct is located deep into the abdomen, the procedure carries longer incisions into the abdomen. Laparoscopy is used to remove the stones in the bile duct.
- Resection of choledochal cysts : There are five types of choledochal cysts that can be managed through different techniques.
- Type 1: They are saccular or fusiform dilatations of the extrahepatic duct and a complete excision of the extrahepatic duct is performed. Biliary-enteric continuity is restored through a Roux-en-Y hepaticojujenostomy.
Type 2: This is an isolated diverticulum protruding from the wall of the common bile duct and the dilated diverticulum is entirely excised and the common bile duct defect is closed over a T-tube.
Type 3: Called the choledochocele it develops from the intraduodenal portion of the common bile duct and therapeutic choice generally depends on the size of the cyst. Endoscopic sphinterectomy is used for choledochoceles < 3 cm and lesions > 3 cm are extracted via a transduodenal approach.
Type 4: Multiple dilations both intrahepatic and extrahepatic bile ducts, exist in the cyst. A Roux-en-Y hepaticojujenostomy is done to completely excise the extrahepatic duct. For intrahepatic ductal diseases, the affected lobe of the liver is resected.
Type 5: This is called Caroli’s disease and contains multiple dilations of the intrahepatic duct and the left lobe. This may require a liver transplantation if there is evidence of liver dysfunction.