Gall bladder and the Biliary Tract

Gall bladder is a pear shaped organ situated beneath the liver. It is connected to the liver and intestines through the biliary tract. The bile ducts carry bile secreted from the liver and this is stored in the gallbladder and released into the intestines through the bile ducts again. Bile juice is a concentrated liquid that primarily breaks down food into energy molecules, to be absorbed by your body. Bile essentially comprises of water, electrolytes, bile acids, cholesterol, bilirubin and phospholipids.

Diseases of the gallbladder and biliary tract

The common diseases that would require surgery on the gall bladder and biliary tract includes gallbladder calculus, choledocholithiasis (CBD calculus), cholecystitis, gallbladder and bile duct cancer or cholangiocarcinoma

Laparoscopic gallbladder surgery :

Laparoscopic cholecystectomy involves removal of the gallbladder for patients with symptoms attributed to gallbladder calculus, the symptoms may vary from intermittent upper abdomen pain to acute severe pain associated with acute cholecystitis. These stones might slip into the common bile duct when it’s called choledocholithiasis. An endoscopy ERCP will clear the CBD stones sometimes, if ERCP fails, the CBD calculi need to dealt with by laparoscopy. Its associated with a short hospital stay of one or two days.

Radical Cholecystectomy for Gall bladder cancer:

Gallbladder cancer a more common disease in Northern India, usually affects the elderly age group. It is sometimes discovered when ultrasound is done for some other problem. Laparoscopic radical cholecystectomy involves removal of the gallbladder, its draining lymph nodes and a small portion of adjacent liver. In case the gallbladder contains cancer and if its early this treatment is sufficient. But in case the patient presents with jaundice or other symptoms and the tumour is unlikely to be early and the patient will need a major open surgery to remove the gallbladder and surrounding liver and bile duct. These surgeries require very good surgical expertise and are usually performed in tertiary gastrointestinal centers.

Choledochal Cyst Excision

Choledochal Cyst is balloon like dilatation of the bile ducts , most commonly outside the liver. The patient usually presents with jaundice, fever or other alterations of liver functions tests. The involved portion of the bile duct can be removed by laparoscopy and bile ducts are joined to the intestines to enable free passage of bile juice into the intestines.

Bile duct Cancer

Bile duct cancer is medically known as Cholangiocarcinoma. It most commonly affects the bile ducts outside the liver but it rarely also affects the smaller ducts within the liver. Patients usually present with jaundice, severe itching and weight loss. Depending on the location of the cancer, patients usually require removal of the right or left side of the liver along with removal of the bile ducts. This is a very major surgery , that requires specialized anesthesia and surgical expertise. The period after surgery requires intensive care for 2 -3 days until the patient’s liver function recovers to normal status.

Patients who are not fit for surgery because of the physical condition or advanced nature of the disease may be treated by stenting or percutaneous biliary drainage to relieve the jaundice

Recurrent Pyogenic Cholangitis

Recurrent pyogenic cholangitis is a disease where stones accumulate within the liver, most commonly the left liver. It is due to repeated infection of the bile ducts within the liver. Patients experience repeated fever and jaundice. Most commonly the involved part of the liver needs to be removed and stones in the bile duct will be removed. A part of small intestine will be connected to the liver and the stomach / duodenum to facilitate subsequent endoscopy. This will help to remove stones if they form again in the remaining part of the liver and bile ducts.

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