9 - Postsurgical Syndromes

Abstract

Cholecystectomy with or without bile duct exploration for cholelithiasis is the most commonly performed operation on the biliary tract. Postoperative symptoms can arise from biliary disorders or extrabiliary disorders, the latter mostly unrecognized pre-existing diseases. Bile duct stones are the most frequent biliary organic cause for postoperative symptoms. They can be prevented by appropriate preoperative tests. Reoperation should be considered only after conservative methods of treatment (antegrade stone extraction, endoscopic papillotomy with or without retrograde stone extraction, flushing and local medical treatment with monooctanoin) have failed or wherever the causative pathology cannot be otherwise treated. Papillotomy and choledocho-duodenostomy (side-to-side) are performed when the papilla is obstructed (by stone or stenosis). While the late results of papillotomy are good and re-stenosis is rare, choledocho-duodenostomy (side-to-side) may give rise to typical postoperative symptoms due to the choledochal blind-sack. The reported frequency of this syndrome, however, varies from author to author. If postoperative symptoms occur after choledocho/hepatico-jejunostomy (end-to-side) they mainly reflect a recurrence of the underlying disease (benign stricture, biliary tract tumour) rather than a sequel of the operation itself. The significance of postoperative biliary metabolic and functional disorders is not yet clear.