Bile ducts surgery
Bile duct surgery is performed for various reasons; cancer, stones, strictures in the bile duct and other bile duct diseases. Bile ducts are small tubes in a tree branching fashion, which brings bile from the liver to the small intestines. Bile helps to digest the fatty portions of our food. Dr. Singh and other surgeons at Forsyth Surgical Associates can perform safe biliary surgery along with optimum medical management as needed.
Most common cause of blockage of bile duct is stones. Less common causes of blockages include cancers of the bile duct (cholangiocarcinomas) and strictures (scars that narrow the ducts after infection, surgery or inflammation). Other bile duct diseases are uncommon, and include primary sclerosing cholangitis and primary biliary cirrhosis. Typically diagnosed in mid-adulthood, these conditions create ongoing inflammation in the bile duct walls, which can narrow and scar the walls. Primary sclerosing cholangitis is more common in men, and 75% of the time it is seen in people with inflammatory bowel disease (ulcerative colitis or Crohn’s disease). Primary biliary cirrhosis is more common in women, and is sometimes associated with autoimmune diseases such as Sjogren’s syndrome, thyroiditis, scleroderma or rheumatoid arthritis.
Biliary atresia is a rare form of bile duct blockage that occurs in some infants two to six weeks after birth, a time when the bile ducts have not completed their development normally. The chronic conditions of primary sclerosing cholangitis, primary biliary cirrhosis and biliary atresia can result in inflammation and scarring of the liver, a condition known as cirrhosis.
Signs & Symptoms – biliary colic or pain
Symptoms of a blocked bile duct may be abrupt and severe (for example, when a gallstone blocks the whole drainage system all at once), or they may appear slowly many years after bile duct inflammation started. Bile duct diseases cause some symptoms when waste products build up in the body. Other symptoms result from the bile ducts’ failure to deliver certain digestive juices (bile salts) to the intestines, preventing the absorption of some fats and vitamins. Symptoms of a blocked bile duct include:
- Yellowing of the skin (jaundice) or eyes (icterus), from the buildup of a waste product called bilirubin
- Itching (not limited to one area; may be worse at night or in warm weather)
- Light brown urine
- Weight loss
- Fever or night sweats
- Abdominal pain, especially common on the right side under the rib cage
- Greasy or clay-colored stools
- A diminished appetite
Treatment of biliary cancer and diseases
To treat a gallstone blockage accompanied by signs of persistent pain or infection, a gastroenterologist or surgeon can remove stones in the bile duct using endoscopic retrograde cholangiopancreatography (ERCP). The endoscope cuts through the base of the common bile duct, allowing a stone to pass through. In some cases the endoscopist may insert various devices into the bile duct to extract the stone. This same procedure can widen an area of scarred bile duct (a stricture) by inserting and expanding a wire coil (called a stent) within the duct. Dr. Singh generally recommends that anyone with a bile duct blockage from a gallstone have his or her gallbladder removed to prevent another blockage.
It’s uncommon to find bile duct cancer early, but if found in the early stages, it can be treated with surgery. When cancer is more advanced, surgery cannot totally remove the tumor. Surgical procedures can help cancer patients feel better, even if they cannot provide a cure. Surgery can reroute the bile duct to allow better drainage.
Because both primary biliary cirrhosis and primary sclerosing cholangitis can cause severe liver failure, a liver transplant may be needed for long-term survival. Several treatments may reduce symptoms or delay the progression of the disease. Medical treatment is deferred to a gastroenterologist. Dr. Singh performs all the surgical procedures in adults for biliary diseases including stones, cancer, and routing bile to another site.