Our Summary

This research study looked at surgeries to remove the gallbladder (laparoscopic cholecystectomy or LC) in England from 2001 to 2013. The goal was to see how often injury to the major bile duct (a tube that carries bile from the liver to the small intestine) requiring follow-up reconstruction surgery occurred, and what factors might make this more likely.

The study found that out of over 572,000 surgeries, only about 500 patients (0.09%) needed this reconstructive surgery. It was less common in patients without a specific inflammation of the gallbladder (acute cholecystitis). Other factors that lowered the risk were the use of a special imaging technique during surgery (on-table cholangiography) and having the surgery performed by a surgeon who does more than 80 of these procedures per year.

However, patients who did need bile duct reconstruction were 10 times more likely to die within a year than those who didn’t need additional surgery.

The researchers suggest using the imaging technique more often, and having gallbladder surgeries done by specialized surgical teams who do a high number of these procedures.

FAQs

  1. How often does injury to the major bile duct occur during gallbladder removal surgeries, according to the study?
  2. What factors were found to lower the risk of bile duct injury during gallbladder removal surgeries?
  3. What did the researchers suggest to decrease the likelihood of needing bile duct reconstruction after gallbladder removal surgery?

Doctor’s Tip

A doctor might tell a patient undergoing bile duct surgery to discuss with their surgeon the use of on-table cholangiography and ensure that the surgeon has experience performing a high volume of these procedures to reduce the risk of injury to the bile duct and the need for follow-up reconstruction surgery. It is also important for patients to be aware of the potential risks and complications associated with bile duct surgery and to follow their doctor’s post-operative instructions carefully for a successful recovery.

Suitable For

Patients who are typically recommended bile duct surgery are those who have experienced injury to the major bile duct during a gallbladder surgery and require follow-up reconstruction surgery. Patients with acute cholecystitis, inflammation of the gallbladder, may be at a higher risk for this complication. Additionally, patients who do not receive on-table cholangiography during surgery or have the surgery performed by a surgeon who does not regularly perform these procedures may also be at a higher risk for bile duct injury.

Timeline

Before bile duct surgery, a patient may experience symptoms such as abdominal pain, jaundice, nausea, and vomiting. They may undergo tests such as blood tests, imaging studies (such as ultrasound or MRI), and possibly an endoscopic retrograde cholangiopancreatography (ERCP) to diagnose the problem.

After the surgery, the patient may experience pain, fatigue, and a temporary change in diet to allow the bile duct to heal. They may also need to stay in the hospital for a few days for monitoring and recovery. Follow-up appointments with the surgeon and possibly a gastroenterologist may be necessary to ensure proper healing and to monitor for any complications.

Overall, the timeline for a patient before and after bile duct surgery involves diagnosis of the issue, surgical intervention, and post-operative care to ensure a successful recovery.

What to Ask Your Doctor

  1. What is the purpose of bile duct surgery and why do I need it?
  2. What are the potential risks and complications associated with bile duct surgery?
  3. How often do complications requiring follow-up reconstruction surgery occur in patients undergoing bile duct surgery?
  4. What factors can increase or decrease the risk of complications during bile duct surgery?
  5. Will I need additional imaging techniques, such as on-table cholangiography, during the surgery?
  6. How experienced is the surgical team in performing bile duct surgery, and how many of these procedures do they perform each year?
  7. What is the expected recovery time and outcome after bile duct surgery?
  8. Are there any alternative treatments or procedures that could be considered instead of bile duct surgery?
  9. What steps can I take to reduce the risk of complications and improve the success of the surgery?
  10. What are the long-term implications or considerations following bile duct surgery?

Reference

Authors: El-Dhuwaib Y, Slavin J, Corless DJ, Begaj I, Durkin D, Deakin M. Journal: Surg Endosc. 2016 Aug;30(8):3516-25. doi: 10.1007/s00464-015-4641-8. Epub 2016 Jan 29. PMID: 26830413