Name of the Procedure:

Excision of bile duct tumor, with or without primary repair of bile duct; intrahepatic

Summary

This surgical procedure involves the removal of a tumor located within the bile ducts inside the liver. Depending on the extent of the tumor and damage to surrounding tissues, the surgeon may need to repair the bile duct after removing the tumor.

Purpose

This procedure is performed to address the presence of a tumor in the bile ducts that can cause obstruction and subsequent liver damage. The goal is to remove the tumor, alleviate symptoms such as jaundice and abdominal pain, and prevent further complications like liver failure or metastasis.

Indications

• Presence of a tumor within the intrahepatic bile ducts
• Symptoms including jaundice, abdominal pain, unexplained weight loss, and changes in stool color
• Obstructive jaundice confirmed by imaging studies
• Compatibility with surgical candidacy based on overall health and tumor resectability

Preparation

• Patients are often required to fast for at least 8 hours before the procedure.
• Medication adjustments may be necessary, especially if taking blood thinners.
• Pre-procedure imaging tests like CT scans or MRIs to assess the tumor's size and location.
• Blood tests to evaluate liver function and overall health.

Procedure Description

1. Anesthesia: The patient is administered general anesthesia to ensure they are asleep and pain-free throughout the surgery.
2. Incision: A surgical incision is made in the abdomen to access the liver and bile ducts.
3. Tumor Excision: The surgeon carefully removes the tumor from the intrahepatic bile ducts.
4. Primary Repair: If needed, the surgeon repairs the bile duct to ensure proper bile flow.
5. Closure: The incision is closed with sutures or staples.

Tools used may include scalpels, surgical scissors, forceps, and electrocautery devices.

Duration

The procedure typically takes between 3 to 5 hours, depending on the complexity and extent of the tumor.

Setting

This procedure is performed in a hospital's surgical suite.

Personnel

• Surgeon: Specializes in liver and bile duct surgery
• Anesthesiologist: Manages anesthesia and monitors vital signs
• Surgical Nurses: Assist the surgeon and manage the operating room environment
• Medical Technicians: Operate specialized equipment, if necessary

Risks and Complications

• Common risks: Bleeding, infection, bile leakage
• Rare risks: Liver failure, damage to surrounding organs, blood clots
• Management: Post-operative care includes monitoring for signs of complications and providing appropriate interventions, such as antibiotics for infections.

Benefits

• Relief from symptoms caused by bile duct obstruction
• Potentially curative removal of malignant tumors
• Improvement in liver function and quality of life, typically noticeable within a few weeks post-surgery

Recovery

• Hospital stay: Typically 5 to 7 days
• Post-procedure care: Includes pain management, wound care, and gradual dietary progression
• Restrictions: Patients should avoid heavy lifting and strenuous activities for several weeks
• Follow-up: Regular check-ups to monitor recovery and ensure no recurrence of the tumor

Alternatives

• Endoscopic stent placement: Less invasive, may help relieve obstruction but not remove the tumor
• Radiation therapy: Non-surgical, may shrink tumors but typically not curative alone
• Chemotherapy: Systemic treatment to reduce tumor size, often used in conjunction with surgery

Pros of alternatives:

• Less invasive
• Lower immediate risk

Cons of alternatives:

• Potentially less effective in complete tumor removal
• May require ongoing treatment and monitoring

Patient Experience

• During the procedure: The patient will be under general anesthesia and will not feel pain.
• After the procedure: Pain management through medications; expect some discomfort and soreness around the incision site.
• Recovery experience: Gradual improvement with a return to normal activities within a few weeks to a few months. Support and guidance from healthcare providers will be available to ensure a smooth recovery.