Department of Surgery, Asian Institute of Medical Sciences and Technology,
Semiling, Bedong, Malaysia
Department of Surgery, Balajee Medical College,
Dr. T. L. Anbumani
Department of Anatomy, Karpaga Vinayaga Institute of Medical Sciences,
Sivaparakasam Kuppu Rao
Surgery, Tagore Medical College,
V. Shrutiy Kamal
Department of Surgery, Saveetha Medical College,
Department of Surgery, University Kuala Lumpur/Royal College Of Surgery,
Department of Physiology, Faculty of Medicine, Aimst University,
Semiling, Bedong, Malaysia
Any surgeon who performs biliary tract surgery should be aware of the various anomalous anatomical situations of the bile ducts. The penalty for ignorance is occurrence of biliary fistulas and common duct strictures. Around 90 per cent of all bile duct strictures are caused by errors in surgical technique at the time of the original cholecystectomy.
The knowledge of bilirubin formation will help in the prevention of gall stones its medical management.
Both heme oxygenase (HMOX) and biliverdin reductase (BLVR) (the main enzymes in BLB metabolism) act on numerous signaling pathways, with unsuspected biological consequences. The interconnections of such pathways have important physiological and pathological outcomes. There is an imbalance in pro- and anti- nucleating biliary proteins, hypersecretion of gallbladder all interact to promote nucleation. Crystallization results in suspension of cholesterol crystals or bilirubinate salts in gallbladder mucin gel and is known as "biliary sludge". Exploration of their role merits attention which offers the possibility of being targeted for therapeutic benefit. The presence of common bile duct (CBD) in Ultrasonography is considered indirect evidence of biliary obstruction. However, the presence of normal ducts does not exclude obstruction.
Conversely, CBD dilation does not imply biliary obstruction; Conversely, CBD dilation does not imply biliary obstruction, as it can be seen in healthy patients after cholecystectomy and as part of the normal process of aging. The benefit of MR is that biliary imaging can be performed without intravenous contrast or ionizing radiation. Functional MRCP can be performed by using intravenous contrast agents that have biliary excretion. HIDA scanning has excellent accuracy in detecting acute cholecystitis. It has been shown to be superior to US as it provides the functional information which is unobtainable by US. Due to regular use of ultrasonography more and more asymptomatic gall stones are diagnosed. Hence it is imperative to know how to manage silent gall stones. Retained gall stones are one of the post-operative complications. So different methods of treating retained gall stones becomes very important.
The reader of this special issue will be able to describe the various modalities available for noninvasive biliary imaging and the benefits and use of each in the diagnosis of various biliary pathologies. The discussion on the congenital anomalies will reduce the injuries to biliary tree and post-operative complications. Young surgeons will be benefited by the experience shared by other surgeons and it will help in reducing morbidity and mortality.