Indications:
The operation is performed to relieve blockage of the CBD. It is usually performed for blockage of the CBD by gallstones that have worked their way into the CBD from the gallbladder. In most cases previous attempts will have been made to remove the stones by a less invasive endoscope procedure called ERCP. This operation may also be performed for obstruction to the bile duct from scarring or tumours. In these cases, removal of the bile duct may be necessary and a reconstruction of the bile drainage is performed.
Procedure:
An incision (cut) is made across the upper abdomen (tummy) below the ribs on both sides. The common bile duct (CBD – the main tube carrying bile from the liver to the intestine) is then opened up. Any gallstones within the duct causing a blockage can then be removed. The gallbladder is removed as part of the same operation, if not already removed in a prior procedure. The CBD is then stitched closed. Sometimes the small intestine is brought up and stitched directly to the CBD to bypass any blockage or narrowing lower down the CBD, allowing bile to continue to enter the bowel. This operation may also be performed using minimally invasive laparoscopic surgery by surgeons experienced in this technique. The benefit would be smaller incisions with less postoperative pain and a quicker recovery from surgery.
- The major risk is leakage of bile from the CBD after it has been stitched closed or stitched directly to the small bowel. Leakage of bile can lead to significant infection within the abdomen if is not drained out.
- The longer-term risk is narrowing of the CBD over the area where it is stitched closed. This may even occur several years later.
After your consultation:
- Obtain authorization from your medical aid and book your bed for your hospital admission.
- Carefully read through pre-operative information provided.
Day before surgery:
- Do not eat/drink after 22h00, the night before your surgery, unless otherwise specified by your surgeon or anaesthetist (you should be fasting for at least 6 hours before the procedure for solids but you are allowed to take clear liquids up to two hours before your procedure).
Day of surgery:
- Arrive for admission at indicated time on ‘Code & Consent’ sheet.
- Change into theatre attire, remove all valuable belongings.
Approximately 3-5 hours
Duration of hospital stay:
- Usually 7 – 10 days (dependent on post-operative progress of patient)
Activities:
- Refrain from strenuous activities (incl. exercise) for at least 4 weeks post-operatively
Back to work:
- Sick leave required is approximately 3 – 4 weeks in total
Some pain and discomfort post operatively may be expected following any operation, but the following measures are used to lessen the pain experienced:
- Warming devises in theatre as well as warm intravenous fluids.
- Intra-operative pain medication through the drip.
- Post-operative medication through the drip, please inform the nurses if you are in pain so that medication will be administered to you.
- As close to one week after discharge as possible. Please contact the rooms to schedule an appointment.
More procedures performed by Dr Jeske
A SKIN INCISION IS MADE AND THE CONTENTS OF THE ABSCESS IS DRAINED.
THE FISTULA TRACT IS IDENTIFIED AND IS OPENED ALONG ITS LENGTH, AND THE EXPOSED INSIDE OF THE TRACT IS THEN CLEANED OUT.
AN OPERATION TO REMOVE AN APPENDIX THAT IS INFLAMED/SWOLLEN/HAS RUPTURED/HAS FORMED AN ABSCESS.
PTC is a procedure performed by a radiologist (specialist X-ray doctor) who takes X-ray pictures of the bile ducts which are tubes inside the liver.
THE PANCREAS IS EXPOSED AND FREED FROM THE ADJACENT ORGANS. THE TAIL (DISTAL) HALF OF THE PANCREAS IS REMOVED. THE BLOOD VESSELS THAT GO TO THE SPLEEN PASS THROUGH THE PANCREAS. AS A RESULT THE SPLEEN ALSO SOMETIMES NEEDS TO BE REMOVED.