Biliary Surgery Overview

Learning Outcomes

• Understand anatomy of gall bladder, pancreas, spleen, and liver.
• Recognize the purposes of biliary surgeries.
• Understand procedural considerations in biliary surgeries.
• Differentiate between various biliary surgeries: gallbladder, liver, spleen.
• Grasp the transplant process in Canada and protocols for death in the operating room.

Biliary Anatomy

• Comprised of liver, gallbladder, pancreas, spleen, and biliary ductal system.
• Triangle of Calot is the landmark for cholecystectomy (gallbladder removal).
• The common hepatic duct is formed by the junction of left and right biliary ducts.
• Cystic artery supplies blood to the gallbladder from the hepatic artery.
• Sphincter of Oddi controls the flow from the pancreatic duct and CBD into the duodenum.

Celiac Axis

• Major abdominal artery arising from the abdominal aorta.
• Main branches include left gastric, splenic, and common hepatic arteries.

Gallbladder Functions

• Concentrates and stores bile, with a capacity of 40 to 70 mL.
• Releases bile into the duodenum for digestion.
• Blood supply comes from the cystic artery.

Perioperative Nursing Considerations

• Administer general anesthesia; patients positioned supine typically.
• Scrub nurses play a key role in preventing blood loss.
• Surgical counts vary between open (major) and laparoscopic (minor) procedures.

Surgical Interventions

• Common procedures include cholecystectomy, splenectomy, pancreatic resections (Whipple), and liver transplants.
• ERCP (Endoscopic Retrograde Cholangiopancreatography) diagnoses biliary tract issues.

ERCP Procedure

• Involves inserting a scope through the mouth into the duodenum for X-ray guidance.
• Contrast dye highlights the biliary tree and identifies blockages.

Instruments for Biliary Procedures

• Laparoscopic instruments include flexible stone forceps, while open procedures use Randal stone forceps.

Cholecystectomy

• Performed either openly or laparoscopically, often due to chronic inflammation or gallstones.
• Majority (90%) are done laparoscopically.

Pancreatic Transplant

• Three main types: Pancreas Transplant Alone (PTA), Simultaneous Pancreas-Kidney Transplant (SPK), and Pancreas After Kidney Transplant (PAK).
• Targets patients with Type 1 Diabetes.

Spleen Functions

• Located in the upper left quadrant; filters damaged blood cells, produces white blood cells, stores blood.
• Lacks regenerative capacity; requires complete ligation of both blood supplies for splenectomy.

Splenectomy

• Indications include trauma, malignancies, infections, and splenomegaly.
• Two approaches: open (emergency) and laparoscopic.

Liver Anatomy and Functions

• Found in the right upper quadrant, responsible for metabolizing nutrients and regulating blood glucose levels.

Lobules & Blood Supply

• Liver divided into functional units (lobules) with portal triads.
• Blood supplied by the aorta (arterial) and inferior vena cava (venous).

Hepatic Resection

• Performed to resect tumors; requires effective hemostasis and intraoperative imaging.

Liver Transplant

• Two donor types: cadaveric and living related.
• Involves multiple anastomoses for hepatic artery and vein connections.

Trillium Gift of Life Network

• Governs organ and tissue donation processes in Ontario and coordinates transplantation services.

Organ Donation Types

• Neurological Determination of Death (NDD) and After Circulatory Death (DCD).
• Consent for donation must be obtained before surgery, requiring legal next of kin approval.

Aseptic Technique

• Maintaining sterile technique is critical during all phases of organ retrieval and transplant.