Bile Duct (Biliary) Surgery

Bile is made in the liver and flows through a network of small ducts that join to form the common bile duct, which passes behind the pancreas and drains into the small bowel. The gallbladder stores bile and empties into this system. When the ducts are blocked, bile backs up into the liver and the bloodstream, causing jaundice (yellowing of the skin and eyes), dark urine, pale stools and itching.

• Bile duct stones that cannot be removed endoscopically
• Strictures (narrowing) of the bile ducts from scarring, inflammation or previous surgery
• Bile duct injuries, including those occurring during gallbladder surgery
• Cholangiocarcinoma (bile duct cancer) and tumours of the ampulla where the duct meets the bowel
• Choledochal cysts and other congenital abnormalities of the ducts

Many bile duct problems are first managed by a gastroenterologist using ERCP, an endoscopic procedure that can remove stones or place a stent to relieve a blockage. When surgery is needed, the affected section of duct is removed and the remaining duct is joined to a loop of small bowel to restore the flow of bile (a biliary reconstruction or hepaticojejunostomy). For bile duct cancer, part of the liver or the head of the pancreas may also need to be removed. These operations are performed by HPB surgeons with specific training in biliary reconstruction and are planned at the multidisciplinary team meeting.

Recovery depends on the operation performed. Simple bile duct procedures may require only a few days in hospital, while major biliary reconstruction or resection for cancer usually involves one to two weeks in hospital and six to eight weeks of recovery at home. Follow-up includes blood tests to check liver function and, for cancer, ongoing surveillance coordinated with your medical oncologist.