What is Cancer of the Gall Bladder (GB)?
As seen in the picture, the gall bladder (green arrow) is a small sac which is located in close proximity to the liver and is principally involved in storing and concentrating bile. The most common pathology associated with this organ is Gall Stones. However, occasionally it can be associated with cancer, although rare. Cancers of the GB is often picked up incidentally when the gall bladder is taken out for stones. If it is an early cancer then the removal of the gall bladder (Cholecystectomy) alone is enough. However, if the cancer is infiltrating in to the wall of the Gall Bladder, it is best served by additional aggressive surgery which often also involves removing the bed of the gall bladder on the liver, often referred to as Segment 4 or Segment 5 resection of the liver. Additional therapy is dictated by the final pathology report.
What is Cancer of the Bile Ducts (also known as Cholangiocarcinoma)?
The bile from the liver and gall bladder flows down in to duodenum through the bile ducts (yellow arrow). Cancer of the bile ducts is also called cholangiocarcinoma. A special type of bile duct cancer where the left and right ducts merge is known as Klatskin tumor.
What is challenging about bile duct cancer surgery?
These are technically very difficult surgeries because of the close proximity to the arterial and venous blood supply to the liver. These are often involved very early on in the disease process making the surgery very technically challenging and often inoperable. At the Liver and Pancreas Center, Dr. Singh and his team are very experienced in complex biliary surgery and extend their expertise to providing comprehensive care for this difficult problem.
Does the Liver & Pancreas Center also look after Bile Duct injuries?
Incidental bile duct injuries caused during surgeries on the Gall Bladder are referred to Dr. Singh and our team from all over the Southern California region. These injuries can range from simple injuries to fairly complex injuries requiring several surgeries. Because of the complexity of these surgeries for anatomical reasons explained above, these are best managed at specialized centers that perform these routinely.
Does the Liver & Pancreas Center also do non-cancer surgery for Complex Stones of the Gall Bladder & Bile Ducts?
Yes. Clearly the advantage of treating and operating on difficult cancers in this region allows for a good degree of comfort for our surgical team to perform these surgeries. Although, the majority of these are clearly done by the General Surgeons, we are happy to provide care for this patient population. We also have an outstanding team of Gastroenterologists who are extremely competent and comfortable removing most of these complex stones endoscopically without surgical intervention.
What is a Choledochal Cyst?
Choledochal cysts are rare cystic lesions of the of the biliary tree. The absolute cause remains elusive, although several theories have been proposed. Many believe choledochal cysts to be congenital in origin. Abnormal reflux of pancreatic secretions into the biliary ductal system is another popular idea of pathogenesis. Symptoms often differ depending on the age of the patient. Adults will commonly present with abdominal pain, related to biliary or pancreatic obstruction, while in the pediatric population jaundice is common. Surgical excision is the treatment of choice as the risk of malignancy can be as high as 20%.