Cholecystectomy and Exploration of the Bile Duct

Gallstones are a common problem, which often needs treatment if symptoms persist. In this article, we discuss the treatment options for gall stones. Cholecystectomy is the surgery performed to remove bile stones, while the exploration of the bile duct is observing the bile duct, for treatment.

What is Cholecystectomy and Exploration of the Bile Duct?

What is Cholecystectomy and Exploration of the Bile Duct?

Bile is a fluid released by the liver and stored in the gallbladder. The main function of the bile is to break down fat into fatty acids and help body indigestion. When the bile is released by the liver, it is sent to the small intestine through a tube-like structure, which is called a bile duct. The bile duct is connected to the liver, gallbladder, pancreas and small intestine.

Sometimes, due to various reasons, gallstones develop in the bile ducts. The surgery conducted to remove the gallstones is known as a cholecystectomy. The exploration of the bile duct is a process by which the doctor observes if something like a stone is blocking the flow of bile from the liver and gallbladder to the small intestine.

When Is It Necessary To Perform Exploration of the Bile Duct?

Exploration of the bile duct is a surgery in which the doctor opens the main bile duct connected from the liver and gallbladder to the small intestine. This is done to check if any kind of blocking exists in the path. Gallstones can be formed in the bile duct that restricts the flow of the bile from the gallbladder and liver to the small intestine. When the bile cannot flow properly from the gallbladder to the small intestine it infects the gallbladder. As a result, the patient experiences bloating, nausea, vomiting, abdominal pain, chest pain, back pain or pain in the shoulder. Apart from that, the blockage in the common bile duct can also cause jaundice in the patient. Moreover, it may also sometimes cause irritation in the pancreas. By observing these symptoms, doctors decide whether the patient needs surgery or not.

How is Cholecystectomy Performed?

Cholecystectomy is a very common surgery in the United States with more than 750,000 people undergoing surgery every year.1,2 Before performing cholecystectomy the surgeons instruct the patient to eat light food the day before and to not eat and/or drink anything after midnight. On the day of surgery, the patient can only take the medicines prescribed by the doctors.

During a cholecystectomy, the surgeon gives general anesthesia to the patient so they do not experience any pain. Then the surgeon does a single cut either below the right side of the rib case of the patient or in the center of their abdomen for locating the bile duct. Once the surgeon locates the bile duct they inject a dye into it and take an X-ray. This shows where the gallstone or blockage is exactly located in the bile duct.

When the location of the gallstone is exactly detected the surgeon makes a cut in the bile duct and removes the gallstone. When all the gallstones are removed the surgeon closes the skin where the cut is made with the help of surgical clips or switches. In some cases, the surgeon also inserts a tube inside the bile duct in such a way that it comes out of the skin. The surgeon fits a plastic bag on the other end of the tube so that the bile is drained into the bag outside the body of the patient. The bag remains in the same place for a few days or weeks and is removed by the surgeon later.

Once the cholecystectomy surgery is successfully done the patient should get relieved from all the discomfort that occurred due to the blockage of the bile duct. The surgery will also reduce the chance of bile infection and jaundice.

Risks Associated with Cholecystectomy or Bile Duct Exploration

Some risks or complications involved with cholecystectomy or exploration of the bile duct include the following:

  • Bleeding
  • Infection
  • Swelling in the bile duct
  • Complications from general anesthesia
  • Bile leak
  • Minor shoulder pain
  • Blood clots
  • Hernia in the scar.

In some cases, the patient may suffer from fever and excessive pain in the incision area after the surgery. But if it persists or if the fever is higher than 101 degrees then immediate attention is required.

The process of cholecystectomy may not be suitable for some patients especially for those who have complicated gallbladder disease or have done any surgery in the upper abdominal part.3 However, the surgeon will determine whether you need cholecystectomy or you can go for some alternatives. One most common alternative of cholecystectomy that the surgeon usually goes for is Endoscopic Retrograde CholangioPancreatography (ERCP). Sometimes doctors apply the procedure to dissolve the gallstone or shatter the stones into some small pieces. However, the drugs used in this process too can have side effects. Again it is seen that these alternatives do not provide complete cure of the condition and the symptoms are likely to come back. Hence, it is always advisable to consume a diet that is low in fat for preventing gallstones in the bile duct.

Cholecystectomy and exploration of the bile duct are common surgeries and are best performed by skilled surgeons. The need to perform these procedures and the possible risks must be discussed before planning the treatment.

References:

  1. Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterol Clin North Am2010;39:157–169, vii. https://www.ncbi.nlm.nih.gov/pubmed/20478480
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4255339/
  3. B. Fernando Santos, L. Michael Brunt, and Michael J. Pucci. The Difficult Gallbladder: A Safe Approach to a Dangerous Problem. Journal of Laparoendoscopic & Advanced Surgical TechniquesVol. 27, No. 6. 571-8. https://www.ncbi.nlm.nih.gov/pubmed/28350258

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