Introduction:
The gallbladder is a small pear-shaped organ located on the right side of the abdomen, just below the liver. The gallbladder's main function is to store bile, concentrate it, and release it at the time of need. The gall bladder squeezes the bile into the small intestine with many ducts called bile ducts. Bile helps in fat digestion. In some diseased conditions, surgical removal of the gallbladder is recommended; the surgery is known as cholecystectomy.
What Are the Indications for Gallbladder Surgery?
The gallbladder is recommended in conditions like:
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Cholelithiasis (Gallstones): Bile substance can crystallize in the gallbladder, forming gallstones. They are more common and usually harmless but can cause pain, nausea, and inflammation.
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Cholecystitis: Infection which occurs as a result of the presence of gallstones. This condition causes severe pain and fever.
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Gallbladder Cancer: Sometimes, the gallbladder gets affected by cancer. It is rare and difficult to diagnose. Until it is diagnosed, it reaches the last stage.
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Gallstone Pancreatitis: Blockage of ducts that drain the pancreas due to impacted gallstones. It also leads to a serious condition, inflammation of the pancreas.
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Large Gallbladder Polyps: Growth that protrudes from the lining of the inside of the gallbladder are gallbladder polyps.
The most common surgery for gallbladder is cholecystectomy. Laparoscopic cholecystectomy has a high success rate. It is a minimally invasive procedure. Four small incisions are made to insert the surgical instrument and a surgical camera. This camera guides the physician to locate and detect the surgery exactly, and this structure can be seen on a monitor connected to the camera. The physician performs the surgery with handheld instruments outside the body, following the guidance of the camera and monitor.
What Is Bile Duct Leakage After Gallbladder Surgery?
A rare but serious complication of gallbladder surgery is a bile leak. This occurs due to damage occurred to bile ducts during the surgery; the duct can be burned, pinched, or cut during the surgery. This damaged bile duct can lead to fluid leakage in the abdominal cavity, restricted bile flow to the liver, or improper duct function. This causes extreme pain and can even be fatal sometimes.
How Common Is This Bile Leakage in Gallbladder Surgery?
Bile duct leakage is rare and uncommon; it happens in a ratio of 1:1000 surgery cases. This condition is most common with laparoscopic surgery but very rare in open cholecystectomy.
Can These Bile Leaks Be Prevented?
Intraoperative Cholangiography (IOC): In this technique, the physician uses a dye injected into the duct channels, and an X-ray is taken. X-ray reveals the clear flow of bile; when this procedure is accompanied by surgery, the risk of bile duct leaks can be minimized by the physician as the preview of the bile duct is very clear. Prevention of all bile duct injuries is not possible, but a reduction in the number is possible with this technique.
What Are the Symptoms of Bile Leakage?
The symptoms of bile duct leakage:
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Chills.
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Fever.
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Severe abdominal pain.
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Nausea and vomiting.
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Swelling of the abdomen.
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Jaundice (yellowish discoloration of mucous membrane, skin, and whites of eyes).
What Are the Diagnostic Procedures and Tests to Confirm the Bile Leak in the Abdomen?
The diagnosis of the bile duct is done by following methods:
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Physical Examination and Medical History: A detailed history of past surgery is taken.
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Blood Test: A detailed blood investigation is done to check on elevated enzyme levels in the blood.
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Intraoperative Cholangiography (IOC): The physician can detect bile leakage right at the time of surgery. A dye is injected into the duct channels through this technique, and an X-ray is taken, which reveals a clear flow of bile.
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Ultrasound: Transabdominal ultrasound (this uses sound and echoes to form images) is done.
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Endoscopic Retrograde Cholangiography (ERCP): It is a test that uses a combination of X-ray and endoscope; a thin, lighted, flexible, long tube is inserted into the digestive tract. Some bile injuries can also be treated with ERCP.
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Magnetic Resonance Cholangiopancreatography (MRCP): Large magnets and radio waves are used to create an image of the organs, the same as MRI (magnetic resonance imaging).
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Percutaneous Transhepatic Cholangiography: Acts the same as IOC.
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Hepatobiliary Scan (HIDA Scan): This scans bile flow from the liver to the small intestine. In this procedure, a radioactive tracer is injected into the arm's vein, followed by a camera that takes pictures of the tracer as it moves through ducts.
What Is the Treatment for a Bile Leak?
The treatment of bile duct is done by:
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Management of the bile duct can be done by ERCP. It is recommended in cases of the absence of complete circumferential interference of the common bile duct. A plastic stent is inserted for four to eight weeks without the usual sphincterotomy.
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It is a minimally invasive treatment.
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ERCP is performed to delineate biliary tree anatomy.
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Once the leaking point is detected, an endoscopic sphincterotomy is done.
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Any bile stones, if present, are removed.
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Patients who underwent sphincterotomy have a stent insertion, usually a 10 F stent of 7 to 12 cm in length.
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Some more innovative techniques are there, but their usage is rare, like trans catheter coiling (coiling of ducts).
Conclusion:
The most commonly performed surgery in the world is laparoscopic cholecystectomy. And bile duct leak remains a significant complication of this surgery. ERCP with stent and sphincterotomy is usually the first-line treatment and has a success rate of more than 90%. In rare cases, coiling of ducts is done to avoid surgeries, in cases like morbid obesity and COPD (chronic obstructive pulmonary disorders) with continued smoking. Trans catheter coiling of the cystic duct for bile leak is an innovative technique that can help to avoid the risk of reoperation in individuals. This can only be done in patients with well-established drain tracts. Bile duct leaks are not common after surgery, But if they occur and are left untreated can lead to serious health complications.
