Cirugía de la Obesidad - Dr. Alberto Daccach Plaza - Guayaquil

SURGICAL PROCEDURES: -cont-

10.- WHAT IS COLEDOCOLITIASIS?

The biliary ducts begin at the liver. Progressively they become thicker forming outside the liver main stems. The right hepatic duct collects the bile from the right hepatic lobe, and the left hepatic duct from the left hepatic lobe. The union of the two ducts from a thicker trunk, of about 8 cm long and 10 mm in diameter, it is called the common duct or coledocoum. This duct ends in the second portion of the duodenum called papilla of Vater. This papilla has a muscle that works as a sphincter. The Oddi sphincter. The bile, once it has arrived at the duodenum, facilitates digestion and the absorption of nutrients. Coledocolitiasis is the presence of stones (litiasis) within the biliary ducts. In the majority

Of the cases these stones proceed from the biliary gall bladder through the biliary ducts through the cystic duct.

11.- WHAT SYNTOMS DOES COLEDOCOLITIASIS CAUSE?

The symptoms may vary; typically, it is associated with a severe pain on the right side of the abdomen, fever or ictericia. Ictericia is the yellowing of the skin and mucous membranes. Fever is very intense with drastic increase and decrease in temperatures accompanied with chills.

12.- HOW IS COLEDOCOLITIASIS DIAGNOZED?

Coledocolitiasis can be diagnosed with an ecosonogram, a CAT Scan or colangioresonnace. Avery interesting exam is the CRE (endoscopic retrograde colangiopancreatography ). A flexible endoscope is introduced through the mouth up to the duodenum. This will allow us to examine the condition of the biliary ducts, even remove stones, thus curing coledocolitiasis.

13.- WHEN TO OPERATE?

Due to the complications that coledocolitiasis might produce (ictericia, severe duct infection, and pancreatitis.) the procedure to follow is: 1.- First: we must remove the stones through CPRE ( no need for general anesthetic) and then proceed with the laparoscopic colecystomy, to prevent the stones that remain in the gall bladder to pass again to the biliary ducts. If the stones cannot be removed with the CPRE, we can remove them by opening the biliary ducts through laparoscopic surgery; we must add that the post op recovery is a b it longer.

14.- WHAT DOES LAPAROSCOPIC SURGERY OF COLEDOCOLITIASIS CONSISTS OF?

In most cases a laparoscopic colecystectomy is performed if the stones have been previously removed by CPRE. If stones persist in the biliary ducts, we make a small incision and remove them with special instruments. In some cases the ducts are so dilated that it is necessary to deviate them with sutures to other digestive organs for proper functioning. (Duodenum or yeyuno).

15.- WHAT ADVANTAGES DOES COLEDOCOLITIASIS LAPAROSCOPIC SURGERY HAVE?

The same as in the colelitiasis case.

16.-WHAT STEPS SHOULD I TAKE FOR BIILIARY DUCT LAPAROSCOPIC SURGERY?

The process is similar to the laparoscopic colecistectomy. 1.- Pre-op: You must be evaluated by your surgeon; he will examine you and study your complete medical history. Before the operation you will need the following test: Ecosonogram, conventional pre-op exams such as thorax x-rays and electrocardiogram. If you are taking medication on a habitual basis, the surgeon will indicate you if you must continue taking it or stop before the surgery. 2.- Surgery: You will enter the hospital 2 hours before the operation to be prepared. The operation has a variable duration depending on each patient. Nonetheless, the correct preparation for the OR, the anesthetic procedure, the stabilization and recovery take time. Your family members should not worry if the stay in the OR is long. This type of surgery must be done step by step without hurry. Six hours after the operation the patient may start to drink liquids if no problems arise. The patient may leave the hospital 48 hours after the post-op period. If anastomosis has been done between the biliary ducts and other organs such as the jejuno and duodenum, liquids should start 48 hours after the operation and the patient will leave the hospital 4 days after the operation.

17.- WHAT HAPPENS AFTER LEAVIANG THE HOSPITAL?

You must rest after you arrive home from the hospital; it is advisable to take short walks around the house. The complications, are few, we do not prescribe analgesics after leaving the hospital. If you have drainage tubing, the surgeon will explain what to do with it and how to take care of it. You may take a bath the day after arriving from the hospital. Ten days after the operation you will go to the doctor's office, who will remove the sutures from the skin. It is very probable that within a week you may return to your normal activities; even go back to work if it does not entail strenuous activities. The presence of fever, abdominal pain, nausea and /or persistent vomiting or oozing from the wound indicates there are complications. You must contact your doctor immediately.

18.- ARE THERE RISKS RELATED TO LAPAROSCOPIC SURGERY?

Any operation as simple as it might be entails a certain degree of risk. The majority of laparoscopic patients experiment few o no complications and quickly return to their normal activities. Complications after the surgery might include: subcutaneous emphysema hemorrhaging, wound infection, post-op pneumonia, deep vein thrombosis and/or pulmonary embolism. Globally the sum of all the complications does not reach 1% of the laparoscopic procedures. Coledocolitiasis surgery might cause biliary leak in some cases (leakage of bile through the drain tubing) you must keep in mind that when the surgeon recommends a surgical procedure it is because the risk is less than a non treated pathology.