HPB

The bile ducts are tubes that carry bile from the liver and gallbladder to the small intestine. Bile is a fluid that breaks down fats in the small intestine during digestion. Bile is made in the liver and stored in the gallbladder.

Ductal disease includes bile duct cancer (called “cholangiocarcinoma”), which may develop anywhere along the biliary ducts and strictures. Bile duct tumors are almost always malignant.

Bile duct cancer can develop in any part of the bile duct — in smaller bile duct branches inside the liver, in the common bile duct nearest the intestine, and in the part of the hepatic duct where the right and left ducts have joined and are leaving the liver. Bile duct tumors that occur at this juncture are called Klatskin tumors. Frequently, these tumors are not detected until adjacent vessels are involved, and this can sometimes either prevent tumor removal or require added complexity with the need for vascular reconstruction.

Bile duct tumor removal is considered as a first option, whenever possible. Because of the frequent involvement of vascular structures in the liver, arteries and veins sometimes must be reconstructed or removed during bile duct resection. Washington University transplant surgeons draw upon extensive experience in revascularization during liver transplantation when performing these procedures.

Patients also may have tumors in the lower portion of the common bile duct, which passes through the pancreas. If a tumor occurs at this end of the duct, surgeons may perform a “Whipple procedure.” In this operation, surgeons remove the head of the pancreas, part of the stomach and small intestine, lymph nodes near the pancreas, the gallbladder, and part of the common bile duct. This procedure requires surgeons to work among some of the body’s most critical blood vessels.

Washington University transplant surgeons may offer the option of liver transplantation to patients with bile duct cancer confined to the bile ducts when surgeons are unable to perform standard resection.

Non-malignant disease of the bile ducts most often involves strictures, or a narrowing of the ducts, which may result from a previous surgery such as gallbladder removal.

Bypass or reconstruction may be performed in these cases, although when strictures are extensive and are associated with significant liver damage (for example, cirrhosis), bypass surgery may not be possible. In these rare cases, liver transplantation may be considered as an option for benign bile duct strictures.