Surgery of the Biliary Tract

After the Second World War the number of biliary diseases has abruptly risen and lithiasis has become in many regions the most frequent surgical disease of the abdomen. At present, though there are perspectives of rational conservative treat­ ment and though endoscopic techniques permit removing some of its complications even without laparotomy, the basic treatment method still remains, and probably shall remain for long the classical surgical intervention. On the contrary, the indications for such intervention are always widening, as its risks become always smaller and the requirements for prevention higher. Many books have been written on the surgery of biliary ducts, but recent knowledge is growing so rapidly that it forces within short periods its new integration and critical assessment. Attention is mostly paid to interventions on the biliary ducts with their wide scope of problems and to the prevention and treatment of postoperative disturbances. New and more perfect diagnostic possibilities and some more suitable technical procedures as well require comparison and verification, introduce new aspects on old problems, and even change some established rules.

Inhalt

1. Surgical Anatomy (Niederle).- Liver and the intrahepatic biliary system.- Extrahepatic biliary system.- Main bile duct and papilla.- Gallbladder and cystic duct.- Blood vessels.- Lymphatic drainage.- Innervation.- Anomalies and variations.- Duodenum and pancreas.- References.- 2. Clinical and Pathological Physiology (Kecl?k).- Secretion and composition of bile.- Motor activity of the biliary tract.- Biliary pain.- Lithogenesis.- Biliary tract obstruction.- Sequels of biliary surgery.- Biliary tract and liver.- Biliary tract and pancreas.- Hepatorenal syndrome.- References.- 3. Preoperative Diagnosis (Keclík, Niederle, Hol?k).- Clinical and biochemical examination.- Special techniques of examination.- Duodenal intubation.- Duodenoscopy.- Needle biopsy.- Laparoscopy.- Minilaparotomy.- Isotopic examination.- Sonography.- Preoperative radiodiagnosis.- Basic radiological examinations.- Instrumental cholangiographies.- Selective angiographies.- Computed tomography.- Choice of diagnostic methods.- References.- 4. General Principles of Biliary Surgery and Operative Diagnosis (Niederle, Blazek, Kecl?k, Jedlicka).- Preoperative preparation of the patient.- Anesthesia.- Laparotomy and abdominal exploration.- Methods of operative instrumental exploration.- Radiology and manodebimetry.- Probing.- Choledochoscopy.- Puncture and biopsy.- Choice of diagnostic methods.- Basic surgial procedures.- Suturing of bile ducts.- Drainage of the gallbladder - cholecystostomy.- Drainage of bile ducts- choledochostomy.- Drainage and closure of the abdomen.- Postoperative management.- Hospital care and control radiology.- Long-term patient follow up.- References.- 5. Gallbladder Diseases and Cholecystectomy (Novák, Kecl?k, Niederle).- Cholecystolithiasis.- Cholecystitis.- Cholecystoses.- Gallbladder dysfunction.- Gallbladder operations.- References.- 6. Bile Ducts Diseases and Their Surgery (Niederle, Holubec, Kecl?k).- Choledodiolithiasis.- Intrahepatic lithiasis.- Benign biliary stenoses.- Stenosis of papilla and sphincteric part of the common bile duct.- Biliary pancreatitis and pancreatic choledochus stenosis.- Cholangitis and inflammatory stenosis.- References.- 7. Biliary Tumours (Brzek).- Tumours of the gallbladder.- Tumours of the extrahepatic bile ducts and the papilla.- Surgery for tumours.- References.- 8. Surgery of Jaundice (Niederle, Kecl?k).- Classification and diagnosis.- Indications for surgery and surgical interventions.- References.- 9. Biliary Fistulas and Anastomoses (Niederle).- External fistulas.- Spontaneous fistulas.- Postoperative fistulas.- Artificial surgical fistulas.- Internal fistulas.- Spontaneous fistulas.- Postoperative fistulas.- Artificial fistulas or biliodigestive anastomoses.- References.- 10. Biliary Anomalies (Niederle, ToSovsfý).- Congenital atresias and stenoses.- Agenesia and hypoplasia of the biliary tract.- Dilatations and cysts of bile ducts.- Congenital common duct perforation.- Duodenal diverticula in the region of the papilla of Vater.- References.- 11. Biliary Emergencies (Novák, Niederle, Tesa?).- Acute progressive cholecystitis.- Acute emphysematous cholecystitis.- Biliary peritonitis.- Acute obstructions of the papilla of Vater.- Gallstone ileus.- Volvulus of the gallbladder.- Hemobilia.- Traumatic damage of the biliary tract.- References.- 12. Surgical Failures and Reinterventions (Niederle, Keclik, Tesa?, Kodlová).- Errors in indications for surgery.- Errors in preoperative patient preparation.- Operative mistakes and injuries, their prevention and immediate repair.- Postoperative complications and urgent reoperations.- Persistent or late symptoms of surgical failures and late reoperations.- References.