Surgical Aspects Of Gaundice:

El Sayed Abd El Latife Hassan

Biliary tract surgery provides a fair(,)I,’ ”-----propori;Jon( -; i-:’ /of the work of every general surgeon. In general, :i,,~-=it may be said that diagnosis is usually straightforwardenough, it is seldom difficult to decide whether or notan operation is necessary and the surgeon is not oftenfaced with technical problems which result in hazard tothe life or health of the patient. For these reasonsmost patients who undergo surgery of this kind havea successful operation and are relieved of theirsymptoms. There are exceptions, however,and ifanything does gowrong with an operation apon thegall bladder or bile passages, or if the cause ismedical rather than surgical, the result is notlikely to be a minor nuisance to the patient buta life-threatening catastrophe. The dangers arenot only those relating to operative technique.Such as the well-known hazard of injury to thecommon bile duct during cholecystectomy; theyinclude the dangers inherent in unsound judgmentor incorrect diagnosis which may result, forinstance, in the surgeon finding himself seekinga stone in the bile duct of an ill, jaundiced patientand finding a hepatic necrosis.-- ------------------------~--r’v - --_The_bad r~~tults of _biliary tract_~ )J.rgerymay - ---- ,-~-=, -=---:-.__ -.____ _,,1 I. -- ----include ._-thea!?!!thof~t :or-(~~’lt~in_~_·;.;~I.~ll~~ela~:~~.~~~=health. In th_e_c~Beof~elatter, the .’ situationis not improved by taking refuge behind the term’post~cllo1ecystectomy syndro~e ’ and leaving it atthat-. Neither should i~:-:be!~.e;htlY_~~!lilumte~d_t _disorders of function o1’.tl:1beili!l..Ia”pYparatus in theabsence of organic disease are anything but rarities.Unsuccessful biliary tract surgery usually resultsfrom one of the following three causes.1. The operation should~ot have been performed; forexample, cholecystectomy for non-calculous, cholecystitis ” the caus~ .01’the patient’s symptomsbeing a-hiatus hernia~c-aduodenal ulcer, diverticulitiscoli or an unfai thfUIhusband~2. The operation has been inadequately performed ;cholecystectomy for calculous cholecystitis but stonesleft in the common bile duct.3. The operation has been improperly performed; forexample, damage to the common hepatic duct leadingto a strH:ture._~_ • -_-::=_’ __ - _~’:’- ••:.•:::- ~:_:’:::::,:::-:’:·:””::w:~.-..~.,:-:-=-::_.::’ -::-’=- ~-_.::.-=-::_.:.._ ~=_=’-=_. ’_.-_-_-’::::_._’_-_.. ~.-.·. . .. , -.,We will deal in that reDearch the Surgicalaspect’s of Jaundice.It con na Lna nine chaptersThe first chapter deal with anatomy, lIisto~ogyand Embreology of liver, dudenwm, pancreuse , BiliaryIlystem.Chapter two deal with physiology of jundicelMetabolism 61’ bile,excretion.Chapter three de~l with Etiology and typos pfjaundice.Chapter four de~l with investigation and dinr~o9ioof jaundice.Chapter five dee! with patholo~y of jaundice.Then we deal with management, etiolo/”J, inVEiDtil~ationor some cases of obotructive jaundice such as Istone or,oommon bile duct, otricture of commoh bileduct, liver tunour,.cancer head of pancreaoe ~ndanpulla of vater.