Gall Bladder & Biliary Tract

The biliary tract consists of the bile duct draining the bile juice from liver to the intestines. Gall bladder drains into the bile duct through the cystic duct. Lower end of the bile duct enters the second part of duodenum . It also goes through the pancreas and hence gets obstructed in any pancreatic head mass. Commonest problem affecting the gall bladder and the bile duct is stones in the gall bladder. This can nowadays easily be treated by laparoscopic cholecystectomy. Majority of bile duct stones can be dealt with by ERCP (endoscopic retrograde cholangio pancreatography).

Laparoscopic cholecystectomy (gall bladder removal) is the gold standard treatment for the treatment of gall bladder stones. It is performed with small key hole insicions in the abdominal wall with special instruments. Main advantages of this laparoscopic surgery are:

• Less pain after surgery
• Short hospital stay
• Early return to work
• Cosmetically small scar of surgery
• Cost effective

Other common diseases affecting the gall bladder and bile duct are:

• benign and malignant surgical obstructive jaundice including biliary strictures
• Carcinoma of the gall bladder, pancreas and the bile duct
• Choledochal cyst

Surgery for benign bile duct stricture, and gall bladder and bile duct cancer are done only at specialized units with surgical and associated disciplines having experience in these areas.

The commonest cause of bile duct stricture is following cholecystectomy. This redo surgery is a complicated procedure and should be performed only by experienced gastro surgeon as first repair is the best chance for the patient.

Cancer of the gall bladder and the bile duct usually present late. Definitive surgical treatment is possible only in cases detected early. Hence in all cases of surgical obstructive jaundice thorough evaluation by a gastrosurgeon is desirable. Cases detected late usually require medical treatment for palliation.