Specialty Procedures: 
Liver and Gallbladder Procedures

Liver Procedures

Common Bile Duct Exploration 
Gallstones within the common bile duct can be removed using a surgical procedure known as common bile duct exploration. This procedure can be done either laparoscopically or during open cholecystectomy. These procedure can be challenging and are best performed by expericenced hepatobiliary surgeons.

ERCP (Endoscopic retrograde cholangiopancreatography) 
ERCP is an endoscopic procedure performed by gastroenterologists and surgeons trained in endoscopy. In this technique gallstones are removed from the common bile duct using a flexible endoscope inserted via the mouth, through the stomach, and into the intestine. Neither general anesthesia or incisions are required for this procedure. Patients with stones in the common bile duct are often managed with a combination of laparoscopic cholecystectomy and ERCP (performed either before or after the cholecystectomy).

Gallbladder Procedures

Treatment for Gallstones 
Surgery is the most effective treatment for gallstones. Laparoscopic surgery is the best option for most patients, although open surgery may be required in some. Non-surgical treatment options are mentioned below.

Open Cholecystectomy 
Cholecystectomy refers to surgical removal of the gallbladder. In the open procedure, general anesthesia is used. A 5-inch incision is made under the right rib cage or in the upper midline, and the gallbladder is removed. Usually, 3-4 days of hospitalization are required. A 4-6 week recovery period at home follows, after which patients can resume full activity. The disadvantages are the pain, the long recovery and the large incision. The advantages are that the gallbladder has been removed and there is almost no chance of further stones forming.

Laparoscopic Cholecystectomy 
During laparoscopic cholecystectomy the surgeon operates miniature instruments under video laparoscopic monitoring. Although general anesthesia is still used, the incisions are each less than an inch in length. Because this procedure is less invasive, there is less pain and the recovery is more rapid than after open cholecystectomy. The procedure usually is completed in less than 2 hours, and most patients can be discharged from the hospital several hours afterwards. Most patients resume full activities within 7 days after the operation.

Non-surgical methods for treating gallstones are associated with limited success rates, but they may be options for patients who are not surgical candidates.

Oral Dissolution Therapy 
Oral medication is used to attempt to dissolve the gallstones. The stones must be small, not too numerous, and not contain calcium. Less than 20% of patients qualify for this treatment; of those who do, only one-third respond to this form of therapy. Even among patients successfully treated, more than half develop new gallstones within 5 years.

Lithotripsy 
In lithotripsy focused shock waves are directed at the gallbladder to attempt to destroy the gallstones. Unfortunately, only 15-20% of patients are suitable for this therapy, and the recurrence rate is similar to that associated with oral dissolution therapy.