Gallbladder disease is one of the most common digestive disorders that people experience in their lifetime.
One of the most frequently recurring issues related to gallbladder disease is the formation of gallstones. These small, hard masses of highly concentrated bile that form inside the gallbladder can cause swelling, pain, infection, blockages, and can even damage the gallbladder itself.
Oftentimes, the only way to alleviate the discomfort of gallstones is to remove the entire gallbladder in what is called a cholecystectomy. The “gold standard” for gallbladder removal is a surgical process called laparoscopic cholecystectomy.
Unfortunately, sometimes during the removal of the gallbladder (via laparoscopic cholecystectomy), the bile duct is commonly damaged.
Today we will look at what a bile duct injury is, how it occurs, and the treatment of such an injury.
What is a Bile Duct Injury?
A bile duct injury is damage to the bile duct during gallbladder surgery. Most commonly occurring during laparoscopic cholecystectomy, and to the common bile duct on the biliary tree, bile ducts can get cut, burned, or pinched leading to painful and sometimes fatal symptoms if not treated.
As a result of the injury, the bile duct no longer functions properly:
- A small hole or tear in the bile duct may cause bile to leak into the abdomen causing pain, inflammation and infection in the abdominal cavity. In addition, the digestive process suffers because the proper amounts of bile are not being delivered to break down fats that are consumed.
- If not treated immediately, the scarring that forms as a result of the injury may create a bile duct stricture, narrowing the bile duct. This stricture prevents bile from draining into the intestine correctly, backs up, and spills into the bloodstream causing jaundice.
Although the numbers vary from study to study, it is estimated that bile duct injuries occur in as many as 1% (or one out of every 1,000) laparoscopic cholecystectomy surgeries.
What Causes Bile Duct Injuries?
Bile duct injuries typically occur when the surgeon misidentifies the common bile duct for the cystic duct during the gallbladder removal.
In fact, a case study of 252 laparoscopic bile duct injuries used to determine the causes and prevention of laparoscopic bile duct injuries found that the primary cause for injury in 97% of the surgeries was due to a “visual perception illusion,” meaning the surgeon could not see correctly and mistakenly damaged the bile duct.
Many factors play a role in a bile duct surgeon’s inability to see the bile ducts correctly during surgery:
- Anatomical structure
- Visceral Fat
- Mirizzi Syndrome
The other 3% of injuries were due to technical faults proving that only a highly qualified, specialized gallbladder surgeon, such as Dr. Fraiman at the Liver and Pancreas Center in Maryland, should conduct your laparoscopic cholecystectomy.
Symptoms of a Bile Duct Injury
If the surgeon performing the laparoscopic cholecystectomy does not notice and fix the bile duct injury at the time of surgery, a patient will begin to experience noticeable symptoms post-operatively that are related to the injury and must be addressed to prevent further infection or damage.
Some of these symptoms include:
- Abdominal pain
- Swelling of the abdomen
One reason the laparoscopic cholecystectomy is held in such high regard, and is labeled the “gold standard” when it comes to gallbladder removal is because of its minimal scarring, decreased risk for infection or complications, and a its one week recovery time period. With the more complicated open gallbladder surgery patients can expect up to 8 weeks of recovery time, among other things.
If you notice after having a laparoscopic cholecystectomy that you are failing to recover within the approximate recovery period, it is suggested you see your bile duct surgeon to rule out a bile duct injury. This is especially true if you are experiencing the onset of jaundice because scar tissue may have formed, consequently restricting your bile duct from draining properly.
Bile Duct Injury Treatment
In about 10-30% of all bile duct injury cases, the damage is detected by the surgeon at the time of surgery. In this situation, the surgeon will then perform a Roux-N-Y-Hepaticojejunostomy to reconstruct the damaged bile duct.
In the case that an injured bile duct goes unnoticed and a patient begins to experience symptoms related to a bile duct injury shortly after his/her laparoscopic cholecystectomy, the doctor will use one of many tests to make a correct diagnosis:
- Transabdominal Ultrasound – Using sound waves and echoes, an image of the abdominal organs will be created to detect the problem.
- Endoscopic Retrograde Cholangiopancreatography (ERCP) – This test involves a lighted, flexible scope inserted into the upper part of the digestive system to take x-rays of the bile ducts. This will check for leaks and blockages in the different areas of the biliary tree.
- Percutaneous Transhepatic Cholangiography – During this test x-rays are taken after the bile ducts have been injected with a dye to get a clearer picture of the bile duct functioning.
- Magnetic Resonance Cholangiopancreatography (MRCP) – Using magnetic resonance and radio waves, images of the bile ducts are recreated and examined for damage.
After a bile duct injury has been detected by your bile duct surgeon, treatment of the infection, leakage, or blockage becomes essential.
The physician will then get to work on repairing the damaged bile duct using the patient’s intestine to bypass the injury and prevent any further complications.
If the injury on the bile duct is located on the lower end of the duct, the surgeon can easily attach a section of intestine to the healthy area of the bile duct above the injury allowing bile to flow freely as part of the normal digestive process.
If, however, the injury is on the upper end of the bile duct, reconstruction becomes more difficult since finding a section of healthy bile duct is less likely to be found. There is also an increased risk of blood vessel damage in this area which could restrict adequate blood flow and hinder the healing process.
If you have a bile duct injury as a result of a laparoscopic cholecystectomy, it is important that you enlist the help of a specialized bile duct surgeon to resolve your injury.
Practicing for over 20 years and specializing in liver and pancreatic surgeries, as well as all associated diseases and injuries (such as bile duct injuries), Dr. Fraiman is just the type of specialized surgeon you need when requiring a gallbladder removal or a bile duct injury fix.
With his dedicated team of specialists aiding him, Dr. Fraiman uses a patient-centered approach to meet the individual needs of all his patients. Consider contacting him today to help resolve all of your gallbladder and bile duct issues so that you can live a long and healthy life.