Search Results

Late symptoms after cholecystectomy In up to 15% of patients, cholecystectomy fails to relieve the symptoms for which the operation was performed. Such patients may be considered to have a ‘postcholecystectomy’ syndrome. In most such cases, this is merely a c...

Learning objectives To understand the surgical anatomy and physiology of the • gallbladder and bile ducts To be familiar with the pathophysiology and management bile ducts • of gallstones

Low insertion of the cystic duct The operating surgeon must identify variations in the anatomy ( Figure 71.21 ) to avoid inadvertent damage to the common hepatic duct or CBD. Complete dissection of the cystic duct ( Figure 71.22 ) should be avoided because th...

Lymphatics The subserosal and submucosal lymphatic vessels of the gall bladder drain into the cystic lymph node of Lund (the sentinel lymph node), which lies in the fork created by the junction of the cystic and common hepatic ducts. E ff erent vessels from...

Magnetic resonance cholangiopancreatography Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive modality that provides excellent images of the gallbladder and biliary system ( Figures 71.11 and 71.12 ). These images are comparable to those ob...

Malignant tumours of the bile duct Summary box 71.7 Bile duct cancer (cholangiocarcinoma) /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Cholangiocarcinoma Incidence Cholangiocarcinoma is an uncommon malignancy . The overall annual inc...

Open cholecystectomy For patients in whom a laparoscopic approach is not indicated or in whom conversion from a laparoscopic approach is required, open cholecystectomy is performed. /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25...

PRIMARY SCLEROSING CHOLANGITIS PSC is a rare idiopathic and progressive biliary tract disease characterised by inflammation and destruction of the intrahe patic and extrahepatic bile ducts that can lead to liver fibrosis and cirrhosis. Association with hypergam...

Percutaneous transhepatic cholangiography This is an invasive technique in which the bile ducts are cannu lated percutaneously . The main indication is to drain intra- hepatic ducts when strictures cannot be accessed at ERCP . The procedure is undertaken after...

Postcholecystectomy choledocholithiasis Any obstruction to the flow of bile can give rise to stasis, with the formation of stones within the duct. Duct stones may be detected many years after cholecystectomy and may also be related to the development of new p...

SURGICAL ANATOMY AND PHYSIOLOGY The gallbladder is a pear-shaped structure, 7.5–12 /uni00A0 cm long, with a normal capacity of about 25–30 /uni00A0 mL. Its anatomical divisions are fundus, body and neck, which terminates in a narrow infundibulum. The gallblad...

Stricture of the bile duct The causes of benign biliary stricture are given in Summary box 71.5 . Bile duct strictures may be investigated radiologically as described in Summary box 71.6 .

Surgical physiology Bile is produced by the liver and stored in the gallbladder before being released into the duodenum. The liver excretes bile at approximately 40 /uni00A0 mL/h. As it leaves the liver its composition is 97% water; the remaining 3% consists o...

TORSION OF THE GALLBLADDER This is a very rare complication, requires a long mesentery and therefore occurs most often in an older patient with a mucocele of the gallbladder. Presentation is with extreme right upper quadrant abdominal pain. Urgent exploration...

TRAUMA Injury to the gallbladder and extrahepatic biliary tree is rare and may occur as a result of blunt or penetrating abdominal trauma. Iatrogenic injury is perhaps more frequent than external trauma. Physical signs are those of an acute abdomen. Manageme...

TUMOURS OF THE BILE DUCT Benign tumours of the bile duct Benign neoplasms such as papilloma, adenoma, papilloma - tosis, leiomyoma and neural and endocrine tumours causing biliary obstruction are uncommon and may be an incidental finding. For symptomatic patien...

Tenets for safe cholecystectomy ( Table 71.5 ) Safe zone of dissection The safe zone of dissection lies cephalad to a line extending from the roof of Rouvière’s sulcus to the umbilical fissure across the base of segment IV (R4U line). The operating - surgeo...

Treatment For breast-fed infants, introducing supplemental formula feeds using a medium-chain triglyceride-based feed and fat-soluble vitamin supplementation (titrated according to growth) is a priority . Patent segments of proximal bile duct are found in 10%...