General Surgery

Gallbladder and Bile Ducts Surgery

Our Procedures

Treatment options

Laparoscopic cholecystectomy for symptomatic gallstones

During this very common procedure the gallbladder is removed and the bile ducts are evaluated with intraoperative imaging (cholangiogram) to assess whether any stones have passed into the bile duct.

Stones that appear in the duct on imaging can be removed during the same anaesthetic for the cholecystectomy, using laparoscopic (keyhole) equipment. This is done either through the connection tube of the gallbladder and the main bile duct (cystic duct) or by opening the main bile duct.

Laparoscopic cholecystectomy complications

A cholecystectomy is considered to be a very safe procedure. The reported mortality rate is less than 0.3%, while studies have shown that the morbidity rate is 2%.

The reported complications from this type of surgery include:

  •  wound infection
  •  clots
  •  bleeding
  •  bile leak, bile duct injury
  •  intra abdominal infection
  •  bowel obstruction

Gallbladder cancer surgery

Occasionally, gallbladder cancer is detected accidentally during laparoscopic cholecystectomy for gallstone disease. If this is the case, a second surgical procedure may follow.

The intent of this procedure is to remove areas which have a high risk of containing small nests of tumor cells. If the gallbladder cancer is more advanced, and without the presence of distant metastasis, some other organs (i.e. intestine and liver) can be invaded by the cancer and may need to be resected to achieve a complete removal of the cancerous tissue.

Knowledge

Gallbladder and Bile Ducts

What is the gallbladder?

The gallbladder is a small pear shaped organ attached to the liver. Bile produced by the liver is stored in the gallbladder between meals before being released into the small intestines during a meal.

What are bile ducts?

Bile ducts are tubular structures connecting the liver with the small bowel. Bile flows from the liver through these ducts via the gallbladder into the small intestine.

What is bile?

Bile is a greenish-brown fluid produced by the liver. It helps the body to absorb fats and some vitamins. Bile is also used to excrete some products of metabolism, including bilirubin and cholesterol.

Gallstones

Often in association with consumption of a rich diet, cholesterol levels in the bile can increase and cause an imbalance. Excess cholesterol can lump together and form a crystal which slowly binds more cholesterol. Consequently, a “stone” develops.

Stones caused by excess cholesterol account for over 80% of all gallstones. The size and number can vary from several marble-sized stones to hundreds of gravel-sized stones.

Gallstones can also form from excessive bilirubin (a decomposition product of the red blood cell pigment haemoglobin) in the gallbladder. Sometimes stones can consist of cholesterol and bilirubin; these are known as mixed stones.

Only one third of all people with gallstones have symptoms, and pain usually occurs when the stones are moving. After a big meal, the gallbladder contracts and the stones may be pushed into the junction of the gallbladder and the bile duct. This may cause significant pain and cholecysthitis (inflammation of the gallbladder).

Sometimes, a stone gets squeezed from the gallbladder through into the bile duct. The duct becomes blocked and bile can no longer properly flow into the duodenum. The obstructed bile flow causes jaundice (yellowing of the skin/eyes) and probably cholangitis (infection in the bile duct).

For patients who have symptomatic gallstones, an ultrasound is performed to visualise the stones in the gallbladder and to look for stones in the bile duct. Blood samples are taken to assess the liver function tests (elevation of them could be associated with a stone in the bile duct).

Gallbladder cancer

Gallbladder cancer is rare and arises from the inner layer of the gallbladder wall (adenocarcinoma). If detected early, the survival rate is good.

In approximately 0.43% of cases, gallbladder cancer is detected “accidentally” during laparoscopic cholecystectomy for gallstones.

Bile duct stones

In about 10% of all patients undergoing laparoscopic cholecystectomy, stones are found in the bile ducts. These stones can cause blockages in the bile ducts or pancreas which may cause severe pain, infection or pancreatitis.

Bile duct cancer

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