Extra-hepatic Biliary System Surgery

The extra-hepatic biliary system (EHBS) is a well-designed drainage structure that carries bile secreted from the liver to the duodenum, the bile being stored in the gallbladder before being excreted under the control of the gastrointestinal autonomic reflexes. The system consists of hepatic ducts, the gallbladder, cystic duct and bile duct (also known as the common bile duct), the latter running dorsal to the gastrohepatic ligament and emptying into the duodenum (Figures 1a and b). The pathologies most commonly diagnosed with the EHBS that require surgery are related to obstruction or trauma of the system, and gallbladder mucoceles. [...]

Key Points

• The pathologies most commonly diagnosed with the extra-hepatic biliary system (EHBS) that require surgery are related to obstruction or trauma of the system and gallbladder mucoceles.
• The clinical signs of biliary disease can be both nonspecific (anorexia, malaise, vomiting, diarrhea, weight loss, epigastric pain, and leukocytosis) and more specific (acholic feces, jaundice, hyperbilirubinemia and elevated transaminases).
• Hepatic biopsy and evaluation of the integrity of the EHBS are essential in all cases as a large percentage of EHBS problems are associated with liver disease.
• Surgical options include cholecystotomy, cholecystectomy, and biliary diversions (cholecystenterostomy); the clinician should proceed to laparotomy only after a full evaluation of the patient, using all necessary diagnostic tests.