Biliary Tract Surgery in Surat
What is biliary tract?
The biliary tree is a system of vessels that directs digestive juices from the liver, pancreas, and gallbladder through a bile duct into the small intestine. Read and know in brief about the disease and basics of Biliary Tract Surgery in Surat.
This runs from the liver to the duodenum (the first section of the small intestine). However, not all bile runs directly into the duodenum. About 50% of the bile produced by the liver is first stored in the gallbladder. This is a pear-shaped organ located directly below the liver.
Biliary tract disease
One of the most common causes of extrahepatic biliary obstruction is choledocholithiasis, with one or more stones in the common bile duct or common hepatic duct causing biliary obstruction.
Most patients with choledocholithiasis report upper abdominal pain, although some patients may remain asymptomatic. Because complete obstruction of the bile duct by the stone may be intermittent, patients may report episodic jaundice.
The initial manifestation of choledocholithiasis can also be an episode of cholangitis. Gallstone pancreatitis manifests with typical features of pancreatitis, including epigastric pain, nausea, and vomiting.
The goals of therapy for choledocholithiasis are to remove the stones from the biliary tree and to decompress the biliary tree urgently if bacterial cholangitis is present.
Stone extraction can be accomplished with ERCP, often preceded by an endoscopic sphincterotomy. In the presence of bacterial cholangitis, when a stone cannot be removed for technical reasons—for example, because of its large size—an endoscopically placed biliary stent can be useful for decompressing the biliary tree.
Primary sclerosing cholangitis
Primary sclerosing cholangitis (PSC) is a long-term progressive disease of the liver and gallbladder characterized by inflammation and scarring of the bile ducts which normally allow bile to drain from the gallbladder.
- Itchy skin.
- Extreme tiredness (fatigue)
- Belly pain.
- Yellowing of the skin and eyes, called jaundice.
- Chills and fever from infection of your bile ducts.
Doctors can’t cure primary sclerosing cholangitis (PSC) or keep the disease from getting worse. However, they can treat narrowed or blocked bile ducts and the symptoms and complications of PSC.
Secondary sclerosing cholangitis
Secondary sclerosing cholangitis (SSC) is a chronic cholestatic biliary disease, characterized by inflammation, obliterative fibrosis of the bile ducts, stricture formation and progressive destruction of the biliary tree that leads to biliary cirrhosis.
First lines of treatment can include mass spectrum antibiotics or drainage of the bile duct that is infected followed by close monitoring. Endoscopic surgery is favoured over open procedures to reduce infection and quicker recovery times. If these fail a liver transplant may be necessary.
Primary biliary Cirrhosis (PBC) is a progressive disease of the liver caused by a build-up of bile within the liver that results in damage to the small bile ducts that drain bile from the liver. Over time, this pressure build-up destroys the bile ducts leading to liver cell damage. As the disease progresses and enough liver cells die, Cirrhosis and liver failure occur.
- Abnormal liver blood test
- Dry mouth
- Abdominal pain
The only “cure” for primary biliary cirrhosis is liver transplant.
Biliary atresia is a gastrointestinal disorder in which the biliary system is closed or absent. Biliary atresia is a rare disease of the liver and bile ducts that occurs in infants. Symptoms of the disease appear or develop about two to eight weeks after birth.
- Clay colour stool
- Dark urine
- Weight loss and irritability
Biliary atresia cannot be treated with medication. A Kasai procedure (also known as a or hepatoportoenterostomy) is done.
Cholangiocarcinoma is an adenocarcinoma of the intrahepatic or extrahepatic bile duct.
Patients typically present with jaundice and pruritus and more generalized symptoms, such as weight loss, anorexia, and fatigue.
Surgical resection of Cholangiocarcinoma and Liver transplantation is a choice of treatment which was decided by your surgeon. Palliative therapy includes percutaneously or endoscopically placed biliary stenting.
Miscellaneous Conditions Causing Biliary Tract Obstruction
Although most bile duct tumours are malignant, some benign biliary lesions result in biliary obstruction and cholestasis.
Tumours of the ampulla of Vater can be benign (adenomas) or malignant (ampullary carcinoma). patients are often jaundiced and may have a palpable gallbladder because of bile duct obstruction distal to the cystic duct. Laboratory findings typically show an elevation of alkaline phosphatase and bilirubin levels.
Imaging studies of the biliary tree will often show dilation, suggesting a distal bile duct obstruction. Further investigation with a side-viewing duodenoscope will reveal the presence of the ampullary tumour. Ampullary adenomas, often seen with familial adenomatous polyposis, can be treated with surgical excision of the ampulla. Whipple’s procedure is the treatment of choice for those with resectable ampullary carcinoma.
Carcinoma of the head of the pancreas can manifest with painless jaundice caused by obstruction of the bile duct as it passes through the head of the pancreas. Weight loss, fatigue, and other constitutional symptoms often accompany cholestasis.
Cholestasis can also result from benign pancreatic disorders such as chronic pancreatitis resulting in pancreatic fibrosis leading to common duct narrowing and cholestasis or a pancreatic pseudocyst causing compression of the biliary tree.
Mirizzi’s syndrome is caused by an impacted cystic duct stone, leading to gallbladder distention and subsequent compression of the extrahepatic biliary tree. Occasionally, the gallstone erodes into the common hepatic duct, producing a cholecystocholedochal fistula.
Patients present with jaundice, right upper quadrant, pain and fever. Ultrasound or CT scanning reveals biliary dilation above the cystic duct. ERCP may reveal the obstructing stone, which can occasionally be removed, but the definitive treatment is usually surgical, consisting of cholecystectomy with surgical repair of the bile duct, if necessary.
Cholestasis can be seen in AIDS as a result of biliary ductal changes seen on a cholangiogram that resemble primary sclerosing cholangitis.
Patients present with right upper quadrant pain and laboratory tests suggesting cholestasis.
Extrahepatic biliary obstruction has been seen with various parasitic infections.
Treatment for stones in the bile ducts
Most stones in the bile ducts can be removed during ERCP. During this procedure, doctors pass an instrument through the endoscope to trap and then pull the stone out of the duct. Gallstones cannot be removed using this technique. Most people who have had ERCP and endoscopic sphincterotomy later have their gall bladder surgery, typically using a laparoscope. If the gallbladder remains, stones in the gallbladder may pass into the ducts, causing repeated blockages. Dr Dhaval Mangukiya with vast experience for Biliary Tract Surgery in Surat available at SIDS Hospital for his expert advice and solutions.