BILIARY TRACT SURGERY

What is Bile Duct Surgery?

It is a sac-shaped organ attached to the lower right side of the liver. It is responsible for storing the bile produced by the liver at a rate of approximately 800-1200 ml per day and emptying it into the duodenum immediately after eating. It has no role in bile production. It concentrates bile 30 times and stores it. Since it increases the density of bile, it prepares the environment for the formation of sludge and stones. In its absence, the body adapts in a short time and normal life and digestive functions continue.

Gallbladder Colic

It is a severe pain that comes intermittently in the right upper quadrant. It often occurs after meals and usually disappears on its own within ½-2 hours. It can rarely last up to 6 hours. Ultrasonography does not reveal any findings other than gallbladder stones. The pain is easily confused with stomach ulcers, kidney stones, liver tumors and pain related to the musculoskeletal system.

Gallbladder colic pain indicates that the disease will progress, that acute cholecystitis is possible and that complications may occur. For these reasons, patients with gallbladder colic should undergo surgery and have their gallbladders removed at the most appropriate time.

Acute Cholecystitis (Gallbladder Inflammation)

Acute inflammatory disease of the gallbladder usually presents itself as the final stage of gallbladder stone disease, which initially presents symptoms in the form of pain attacks. However, approximately 10% of patients have silent stones that have not previously shown symptoms. The stone that sits at the gallbladder outlet blocks the bile duct. The gallbladder cannot empty and the pressure inside increases. Inflammatory disease occurs with the growth of bacteria. The risk of surgery performed during acute cholecystitis increases.

Patients consult a doctor with a different and more severe, continuous pain than gallbladder colic. Abdominal examination findings are clear. Laboratory examinations show leukocytosis (increase in white blood cells) and elevations in liver tests such as bilirubin, ALT, AST, GGT, AP. Diagnosis is easily made with ultrasonography.

In patients whose diagnosis and treatment are delayed, life-threatening complications such as gallbladder gangrene, gallbladder perforation (perforation), abscess formation in the abdomen, peritonitis, sepsis (bacterial growth in the blood) and shock occur.

When acute cholecystitis develops, the serious complications listed above are seen at a rate of 10%. Therefore, a patient with gallstones should be treated before having acute cholecystitis if there is no condition preventing surgery and should not be exposed to these risks. Surgery is technically easier within the first 72 hours after acute cholecystitis develops. Patients who apply during this period should be taken to surgery without delay and their gallbladders should be removed. Surgery is technically difficult in patients diagnosed later, and it is appropriate to perform surgery 6-8 weeks after the acute cholecystitis has subsided following antibiotic treatment.

Asymptomatic (Without Symptoms) Gallbladder Stone Disease

It is found incidentally during check-up or examination of other complaints. In cases treated as ulcers or gastritis, it should be shown that the complaints are not related to gallstones. It should be explained to the patient well that asymptomatic stones may cause problems in the future.

Approximately 50% of asymptomatic gallstones do not cause any problems throughout life. 40% become symptomatic and the remaining 10% turn into acute cholecystitis and complicated acute cholecystitis.

The risk of death in laparoscopic gallbladder removal in asymptomatic gallbladder stones is very low (0.01%). The risk of death in the same surgery for acute cholecystitis can be up to 5%. It is beneficial to remove the gallbladder to protect the patient from this risky situation.

Gallbladder Cancer

It is an extremely poorly prognosis cancer that is usually seen in older ages. Chronic stone disease is a risk for cancer. If the diameter of the gallbladder stone is larger than 2.5 cm, the risk of developing cancer increases. The level of the cancer marker called Ca 19-9 in the blood is high. Since it is usually diagnosed in advanced stages, the chance of curative treatment is extremely low. In surgical treatment, the gallbladder is removed along with the adjacent liver tissue and the lymph nodes around the liver vessels.

Porcelain Gallbladder

It is a disease characterized by widespread calcification in the gallbladder wall. It is seen in ultrasonography and X-rays. It can develop after a widespread inflammatory event. Since it is a disease that carries the risk of developing cancer afterwards, it must be operated on.

Gallbladder Polyps

They are masses that are attached to the gallbladder wall. Their diameters can vary from a few millimeters to a few centimeters. If cholesterol crystals accumulate in the gallbladder wall in a way that leads to stone formation, they form cholesterol polyps. Cholesterol polyps can grow and break away from the wall and fall into the gallbladder. True polyps should be monitored if they are smaller than 7 millimeters. Larger ones should be operated on because they carry a risk of cancer.

Bile Ducts

Bile salts, bound bilirubin, cholesterol, phospholipids, proteins, electrolytes and water are excreted from liver cells into small bile ducts called canaliculi within the liver. Canaliculi form the bile ducts located in the right and left lobes of the liver, and these ducts join to form the combined bile duct. The combined bile duct joins the gallbladder duct (cystic duct) at a slightly lower level and is called the main bile duct (choledoch). Then, after running a little behind the pancreas gland, it opens into the duodenum through an opening called the ampulla of Vater. Bile duct diseases are seen as a result of pathologies that occur anywhere in this anatomical structure. Depending on the pathologies that may occur and their level, clinical and laboratory findings vary. When the flow of bile to the duodenum is blocked, the bile produced accumulates in the bile ducts and the liver, creating serious problems.

Choledochus (Main Bile Duct) Stone

Every patient who will undergo gallbladder surgery should be examined for the presence of stones in the bile duct before surgery. In the blood test, total bilirubin, GGT and AP blood tests are high. When infection is added to the picture, fever and shivering also occur. Obstructive jaundice occurs in patients. Ultrasonography may not show main bile duct stones. In suspicious cases, ERCP (endoscopic bile duct examination) should be performed first and if there are stones, they should be removed at the same time. If ERCP is unsuccessful, the main bile duct is opened with surgery and the stone is removed.

Cholangitis (Bile Duct Inflammation)

Patients present with jaundice, fever and chills. If not treated early, shock and loss of consciousness develop rapidly. Most have a problem that causes obstruction of the bile ducts (such as stones or tumors). Patients should be started on antibiotics and supportive treatment immediately, and if there is no response within 24-48 hours, ERCP, PTC (percutaneous transhepatic cholangiography, interventional radiologists entering the bile ducts with a needle inside the liver) or one of the surgical methods should definitely be applied to drain the bile ducts. In patients who respond to drug treatment, a detailed investigation should be performed as soon as possible to determine the cause.

Sclerosing Cholangitis

It is a rare disease that is usually seen in middle-aged men, of unknown cause, and affects all of the extrahepatic bile ducts and some of the intrahepatic bile ducts. Its occurrence together with diseases such as ulcerative colitis, Crohn's disease, Riedelstroma, retroperitoneal fibrosis, porphyria acutanea tarda indicates that it is an autoimmune disease. It carries a serious risk for cancer development in the bile ducts. While symptomatic treatments are performed at the beginning, liver transplantation is inevitable in advanced stages.

Bile Duct Cysts

It is one of the congenital diseases of the bile ducts. Although it is a childhood disease, it has also become common in adults. Patients usually consult a doctor with jaundice, pain and a mass. Patients with cysts in the bile ducts are at serious risk for cancer development. Therefore, if possible, they should be surgically removed. Since the risk of cancer does not disappear even after the cyst is removed, patients should be closely monitored. Some bile duct cysts are widespread on both sides of the liver (Caroli disease). In this case, liver transplantation is the only option.

Bile Duct Tumors

Papilloma is the most common benign tumor of the bile ducts. It is usually seen in the area where the bile ducts are located in the duodenum. It has a very high risk of recurrence and turning into cancer. It is likely to have stones in the bile duct. It should be surgically removed with the bile duct.

Bile duct cancer is usually seen in older ages. It is often associated with diseases such as ulcerative colitis, primary sclerosing cholangitis and bile duct cysts. It progresses very quickly. It can spread through blood and lymphatic flow even in the early stages. Depending on the area where it is located, the tumor is removed with the surrounding tissues and a new bile duct is created to ensure the flow of bile to the intestines.

The information contained within the site is for support purposes only. It does not replace a physician's examination, diagnosis, and prognosis of a patient for medical purposes.

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