Cholecystoenterostomy; direct
CPT4 code
Name of the Procedure:
Cholecystoenterostomy
Common name: Gallbladder Bypass Surgery
Summary
A cholecystoenterostomy is a surgical procedure in which the gallbladder is directly connected to the small intestine to bypass an obstructed bile duct. This enables bile to flow from the liver into the intestines.
Purpose
The procedure is used to treat bile duct obstruction, which can cause jaundice, infections, and liver damage. The goal is to provide an alternative pathway for bile drainage, relieve symptoms, and prevent complications.
Indications
- Persistent jaundice due to bile duct obstruction
- Bile duct tumors or strictures
- Recurrent biliary infections
- Non-amenable to endoscopic or other less invasive procedures
Preparation
- Preoperative fasting as instructed by the healthcare provider.
- Stopping certain medications such as blood thinners prior to the procedure.
- Pre-operative imaging studies like an ultrasound, MRCP (Magnetic Resonance Cholangiopancreatography), or CT scan.
- Blood tests to assess liver function and overall health.
Procedure Description
- The patient is placed under general anesthesia.
- A surgical incision is made in the abdomen to access the gallbladder and small intestine.
- The surgeon creates an opening in the gallbladder and a corresponding opening in the small intestine.
- The two openings are sutured together to form a new passageway for bile to flow directly into the intestine.
- The surgical site is closed, and the patient is moved to recovery.
Tools, Equipment, and Technology
- Scalpel and surgical tools
- Sutures
- General anesthesia equipment
Duration
The procedure typically takes 2 to 3 hours.
Setting
Generally performed in a hospital operating room.
Personnel
- Surgeon specializing in gastrointestinal surgery
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection at the surgical site
- Bile leakage
- Potential injury to surrounding organs
- Blood clots
- Anesthesia-related risks
- Postsurgical adhesions
Benefits
- Relief from jaundice and associated symptoms
- Prevention of recurrent biliary infections
- Improved liver function
- Enhanced overall quality of life
Recovery
- Hospital stay of a few days post-surgery for monitoring.
- Pain management with prescribed medications.
- Gradual reintroduction to normal diet.
- Instructions on wound care and activity restrictions.
- Follow-up appointments to monitor recovery.
Alternatives
- Endoscopic biliary stenting (less invasive)
- Percutaneous transhepatic biliary drainage (PTBD)
- Surgical resection of the bile duct obstruction (when feasible)
- Cons: Alternative procedures may not be suitable for all patients and may offer temporary relief compared to the more permanent cholecystoenterostomy.
Patient Experience
During the procedure, the patient will be under general anesthesia and feel no pain. Post-operatively, they may experience some discomfort at the incision site, which is manageable with pain medication. Gradual improvement in symptoms should be noted within days to weeks.