KTPH Hepato–Pancreato–Biliary Surgery Service (HPB)

ERCP and Stenting

This is a condition where the gallstones from the gallbladder are compressing or eroding from the cystic duct of the gallbladder and blocking the common bile duct draining the bile flow out of the liver. This is treated temporarily with placement of a stent in the bile duct past the blockage of the gallstone. A course of antibiotics is given to treat and prevent infections during the procedure. Additional imaging or diagnostic procedures may be needed to evaluate if the gallstone has eroded into and caused severe scarring above the common bile duct, the anatomy and damage to blood vessels and organs nearby, or if there are areas suspicious for abnormal or possibly cancerous tissue growth.

Mirizzi's Syndrome Operative Repair

When your medical conditions have been optimised for an operation under general anesthesia, your surgeon will coordinate the operation date. The operation will generally free up the gallbladder from scar tissue and enter into the bile duct to remove the stone, leaving a cuff of gallbladder neck tissue to close over the entry site into the bile duct. The stent placed before the operation is usually left in place after the stone is removed to protect the closure site on the bile duct while it heals - it is removed in a separate endoscopic procedure scheduled after a few weeks. A drain temporarily is left near to this closure site to allow any fluids in that area to be removed while it heals - if there is no leakage of bile, it can usually be removed in a few days. Rarely there is a leak of bile, and the drain will be left in position until it seals on its own.

At times the severe scarring above the point the gallstone has entered into the bile duct or suspicion of a cancer requires removal of the scarred section of the main bile duct and reconstruction using a section of small intestine brought up to connect directly to the healthy upper portion of the bile duct (hepaticojejunostomy).