Common bile duct ( CBD) surgery as the name suggests involves surgery of the common bile duct either by conventional open surgery or minimal access surgery also called as laparoscopic surgery . Common bile duct is the drainage tube of the liver which drains the liver and pancreatic juices in to small intestines which aids in digestion. The laparoscopic surgery is performed by placing the specialised instruments in the abdomain and performing surgery on the monitor under complete vision.
Common bile duct surgeries are routinely performed surgeries due to various causes and involves appropriate team work. With the advancements of techniques and improvisation of surgical skills the surgical results of common bile duct surgeries have become excellent with time.
The types of common bile duct surgery performed either via open conventional surgery or laparoscopic surgery are Common Bile duct exploration for stones , common bile duct excision for cancers, cysts and strictures( narrowing) of the bile ducts and Hillary drainage procedures.
Indication of Common Bile Duct surgery
- Primary common Bile duct cancers ( Cholangiocarcinoma)
- Cancer of the gallbladder extending in to the Gall bladder
- Common bile duct stones ( multiple large stones)
- Common bile duct stones in case of unsuccessful endoscopic removal of stones
- Common bile duct strictures
- Choledochol cyst
- Biliary drainage procedures in cases of strictures and unresectable ( inoperative) pancreatic cancers
Once you are planned for surgery the surgeon will explain all the details , it’s risk involved , informed consent and recovery protocols after the surgery they are planning to perform. Usually the length of the procedure will depend upon the extent of the surgery.
- Surgery is performed under General anaesthesia
- Particular position of the patients according to the area of the surgery is given to the patient (commonly done in supine position)
- Technically incision is given upon extent of surgery and preference of surgery
- In laparoscopic surgery, Small hole are made to enter the abdomain using video scope to assess the complete abdominal cavity and area of the disease.
- Mobilisation of the hilar plate up to pancreatic part of common bile duct is done in case of cancers and cyst.
- Surgery is performed using specialised instruments, energy sources , clips to separate the disease part from the healthy part of common bile duct
- The diseased part is the bile duct removed in cancers and strictures and the abdominal drain is placed in abdominal cavity.
- In cases of bile duct stones, after removal of stones ante-grade stent or T tube is placed and then bile duct is closed. In some cases, bile duct drainage procedures are performed to drain the bile especially in cases of narrowing of lower part of CBD.
Recovery after surgery
- The patient is kept in surgical intensive care unit or postoperative recovery unit for initial observation and management. Bleeding, infection and liver failure are major risks involve after these surgeries.
- Intensive chest physiotherapy is advised for enhanced recovery of the patients as breathing might be hampered because of long incisions and pain associated with them.
- Diet is usually started once your bowel function starts returning after surgery.
- Early mobilisation of the patient is recommended.
- Routine check up of your blood will be performed to study your recovery, liver functioning and chances of infection.
- Diet is managed with the help of the dietician to enhance your recovery and protein supplements are added.
Advantages of Laparoscopic common bile duct surgery
- Big incision is avoided which is used in conventional surgery which causes significant discomfort and pain.
- Early recovery
- Early healing of the wound
- Shorter stay of hospital
- Early mobilisation and early return to work
- Scar is minimal
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