Hepato-Pancreato-Biliary Surgery – A Detailed Overview
Biliary surgery is performed on the bile duct, which connects the liver and the gastrointestinal tract. This duct carries bile, which is responsible for dissolving lipids in your diet to be absorbed into the body. Biliary surgery is needed if a tumor or gallstone disrupts the flow of bile.
Biliary Surgery in India is carried out in a single operation, and it is usually an open surgery with general anesthesia and usually, a brief hospital stay for recuperation. Depending on the symptoms, the surgery may be carried out in various ways.
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Speak to your surgeon to discuss your particular condition to find out which type of surgery you need.
What is Open Bile Duct Exploration?
Large bile duct stones and stones that are broken or impossible to remove with other methods are generally removed with an open surgery. This open operation involves making a 15 to 25 cm incision at the abdomen, right under the rib cage on the top right side. This gives the surgeon access to the bile duct and he removes the stones.
ERCP and Sphincterotomy
This is an endoscopic technique in which a flexible telescope is passed through your mouth into the small intestine and the stones are removed by cutting open the small valve at the place where the bile duct and intestine meet, to remove the stones. Instruments like balloons and baskets are passed up the bile duct from below. It is a relatively safe procedure.
Laparoscopic (Keyhole) Surgery
Laparoscopic surgery is an alternative to open surgery. It involves inserting a thin lighted tube through small incisions to look at the bile duct and perform minimally invasive surgery. However, this is a technically difficult operation since the location of the bile duct in the abdomen is hard to reach. Success is usually 60 percent unless the surgeon is very skilled. There are only a few centers that offer this type of surgery and most biliary surgeons use open surgery instead. Only pursue this procedure at centers that have a lot of experience in laparoscopic bile duct surgeries and highly experienced surgeons.
The advantage of laparoscopic bile duct surgery is that there is far less discomfort and post-operative hospital stays are as short as 1 to 3 days.
Specific laparoscopic procedures in the bile duct include,
- Laparoscopic bile duct exploration – This procedure is used to remove stones that have slipped into the bile duct, and it is carried out during a laparoscopic gallbladder removal (through a procedure called laparoscopic cholecystectomy). Sometimes, small gallstones can pass into the duct and obstruct bile. This can lead to pancreatitis and jaundice. If stones are discovered in your bile duct during laparoscopic gallbladder removal, your surgeon will use advanced laparoscopic techniques to reach the bile duct and remove the stones. Usually, instruments are passed into the bile duct and stones are fished out with the help of X-ray. It is only suitable for cases where the bile duct is diluted and contains only a few small or medium stones.
- Laparoscopic bile duct bypass – A bile duct stricture (or narrowing) can be caused by cancer as well as non-cancerous conditions. In such situations, bile is blocked from draining into the intestine, and it builds up in the blood, leading to jaundice. The solution often is a bile duct bypass. During this surgery, a small stent (tube) may be inserted into the bile duct through an endoscopy. When it is not possible to insert a stent, your doctor will cut the bile duct above the tumor or injury and rejoin it to the bowel.
- Resection of choledochal cysts – congenital cysts in the bile duct can also lead to jaundice and pancreatitis and even cancer if not treated timely. Some patients may be offered a laparoscopic removal of the cysts, depending on their condition. The cysts are removed and the bile duct is attached to the intestine for normal function.
- Laparoscopic Whipple Procedure – patients with ampullary tumors (tumor in the area where the bile duct enters the intestine) may be able to have laparoscopic Whipple operation to remove the tumor. Whipple operation involves removing the head of the pancreas, a piece of the bile duct, the duodenum and the gallbladder. The remaining bile duct, pancreas, and intestine are attached back into the gastrointestinal system.
This is a surgery recommended when all other methods fail or in patients who aren’t fit for surgery. Needles and tubes are passed through the abdominal wall to access the bile ducts.
Possible Risks & Complications of Biliary Surgery
- Overall risks of open surgery and keyhole surgery are low. But keyhole surgery tends to cause comparatively more injury to the bile duct.
- If there is a complication with open surgery or there are recurring bile duct stones, your surgeon may carry out an additional procedure for better drainage. The bile duct will be ‘replumbed’ usually with pieces of your bowel. This is a major surgery that has a greater risk of complications as compared to laparoscopic techniques but it is a highly efficient operation.
- In Sphincterectomy, there are small risks of hemorrhage, pancreatitis, cholangitis (an infection of the bile duct) and punctures in the small intestine.
After Biliary Surgery Procedure
Your doctor will tell you more about post-operative care at home.
If you undergo open surgery, you will need to stay at the hospital for a week to ten days. Most patients take about 8 to 12 weeks to return to normal activities.
After keyhole surgery, unless you do very heavy manual labor (for which you should take 3 to 4 weeks off work), two to three weeks are enough for recovery.
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