Bioliary Surgery

Laparoscopic cholecystectomy

  • Laparoscopic cholecystectomy (gallbladder removal ) is indicated when the gallbladder contains stones and is giving biliary symptoms. Those includes pain in right upper quadrant ( below the right rib cage) which can be radiated to the back, the right shoulder and/or the centre of the abdomen.  The pain usually comes after fatty or large meals and can be associated to nausea, vomiting and temperature (please note , not all those symptoms should be present to make diagnosis and gallstones are not the only cause of those symptoms) . 

    At this point indication to remove the gallbladder is given and the procedure can be performed by keyhole surgery. This can be offered as a day case surgery but is some occasions the patients is kept in for one or more nights before discharge. Laparoscopic cholecystectomy can be associated with serious risks including, bleeding, infection, bile leak, bile duct injury, bowel injury and conversion to open surgery.  Bile duct injury is a serious complication and occurs in 1/200 patient having this procedure in the UK each year. It is therefore important that only surgeons with special experience in laparoscopic cholecystectomy undertake this procedure to ensure patients safety and outcomes. 

 

Bile duct exploration

  • Occasionally, small stones can pass from the gallbladder into the bile duct. Stones in the bile duct can cause obstruction leading to the development of jaundice and pancreatitis In some cases the stone can pass from the bile duct to the gut spontaneously. If the stone remains in the bile duct the treatment is by removing it endoscopically (using a camera), if this fails then it can be removed using laparoscopic surgical techniques. Cleaning the bile duct can be performed at the time of the laparoscopic cholecystectomy (removal of the gallbladder) to save the patient a second operation. This procedure needs advanced laparoscopic techniques and should be performed by expert surgeons.

 

Bile duct bypass

  • In patients who develop strictures (narrowing) of the bile duct due to recurrent episodes of inflammation (mostly related to stones or pancreatitis), biliary drainage into the intestine can be impaired and the bile can accumulate in the blood causing jaundice (yellowing of the skin and eyes). Another cause of benign strictures of the bile duct, is injury during previous laparoscopic gallbladder removal. The treatment for benign bile duct strictures is called � biliary by pass� this involves the division of the bile duct proximally (high, nearer to the liver) to the stricture, closing the lower end and joining the upper end to the small bowel.

 

Choledocal cysts

  • This is an abnormal dilatation of the bile duct, usually congenital in origin. Choledocal cysts can lead to the development to of jaundice, pancreatitis and cancer in some patients, if left untreated for many years. The treatment should be complete removal of the cyst. The lower part of the duct is then closed and the proximal part is joined to the small bowel. Traditionally this has been done by open surgery, but I regularly perform this using keyhole surgical techniques with excellent results.