Chirurgie hépatobiliaire
1. Gallstones (Cholelithiasis)
Gallstones are solid particles that form in the gallbladder and may sometimes migrate into the bile ducts. This is a common condition, affecting approximately 25% of individuals over the age of 50. It is more frequent in women and individuals who are obese or have certain medical conditions. Gallstones can be made of cholesterol (about 80%) or bile pigments (20%).
Symptoms
Many people with gallstones experience no symptoms. When symptoms do occur, they can include:
- Pain: Upper abdominal pain, typically after eating fatty foods, lasting less than six hours.
- En cas d’obstruction : jaunisse, angiocholite, pancréatite
- If a gallstone blocks the bile duct, it can lead to complications like jaundice, cholangitis (infection of the bile ducts), or pancreatitis.
Treatment
- Cholecystectomy:
The standard treatment for symptomatic gallstones is the removal of the gallbladder. This is usually performed through laparoscopy (minimally invasive surgery with small incisions). - Advanced Techniques:
Our team is skilled in using micro-laparoscopy (incisions as small as 2-3 mm) and single-port laparoscopic surgery (one incision at the belly button). - Stones in the Bile Duct:
If a stone moves into the bile duct, it may be treated with an endoscopic procedure to widen the bile duct opening (sphincterotomy).
Risks
- Bleeding: Usually controlled during the laparoscopic procedure.
- Bile Duct Injury: This can occur in cases of significant infection or unusual anatomy. Our team is highly experienced in managing these rare complications.
Post-operative Care
- After surgery, patients are typically seen for a follow-up appointment one week later (if treated as an outpatient) or one month later (if hospitalized).
- Most people recover quickly and do not require long-term monitoring.
2. Pancreatic Tumors
The most common pancreatic tumor is ductal adenocarcinoma, though there are several other types, including benign (serous cystadenoma, lymphoepithelial cyst, lymphoplasmacytic sclerosing pancreatitis), potentially malignant (intraductal papillary mucinous tumors, mucinous cystadenomas), and malignant (acinar cell adenocarcinoma, mucinous cystadenocarcinoma, non-Hodgkin lymphoma, and metastases from other cancers). Endocrine tumors (such as insulinoma, glucagonoma) cause specific syndromes and are not covered here.
Symptoms
Symptoms often appear late and can include:
- Weight loss
- Fatigue
- Painless jaundice
- Abdominal or back pain
- Malabsorption
- New-onset diabetes
- Incidental discovery during imaging
Treatment
Diagnosis by clinical examination, blood test, imaging (CT, MRI) and often biopsy.
- Surgery: Main treatment, sometimes preceded by chemotherapy. Laparoscopic approach possible (especially for distal cases), or laparotomy. Minimally invasive techniques are preferred in our center.
Surgery involves removing the affected area, sometimes along with nearby organs. If the head of the pancreas is affected, reconstruction is necessary. If the spleen is removed, a preventative vaccination is given.
Post-Operative Care
- Diet: Resume on the first post-op day or 3-4 days later, depending on the surgery.
- Hospital Stay: Usually 3-4 days to 10-12 days. Fragile patients may require a brief ICU stay.
- Possible transfer to intensive care
- Risks: Pneumonia, bleeding, and healing issues are the main risks, but these are manageable with modern techniques.
- Follow-up at 3 weeks, then every 3 to 6 months for 5 years
- Post-operative chemotherapy often recommended
3. Liver tumors
Liver tumors can be either malignant (such as hepatocellular carcinoma and hepatic metastases from other cancers) or benign (including biliary cysts, angiomas, focal nodular hyperplasia, and adenomas).
Symptoms
Liver tumors are often discovered incidentally during routine imaging exams or when investigating conditions that may predispose to them, such as cirrhosis (for hepatocellular carcinoma) or cancers from other organs (for metastases). Less commonly, they may cause:
- Right upper abdominal pain
- Fatigue
- Loss of appetite
- Weight loss
Treatment
Diagnosis is made based on a combination of clinical examination, blood tests, and imaging (such as ultrasound, CT, or MRI). In some cases, a biopsy may be required to confirm the diagnosis.
- For Malignant Tumors:
Once diagnosed, the patient is informed by the responsible physician. A complete assessment is carried out to evaluate the extent of the disease and determine whether surgery is feasible. This assessment is discussed in a multidisciplinary team meeting to plan the most appropriate treatment. - Traitement principal : chirurgie, ou techniques radiologiques (embolisation)
- Approches chirurgicales : laparotomie ou laparoscopie (classique ou par trocart unique)
- Reprise alimentaire le lendemain
- Hospitalisation d’environ une semaine
- Soins intensifs possibles
- Risques : complications pulmonaires, saignements, fuites biliaires
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Call Us
Medical secretaries: 8:30 - 17:00, Monday to Friday. Tel.: +33 1 45 37 43 39 | +33 1 45 37 43 48
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Cécile.huber@aphp.fr
Ibrahim.dagher@aphp.fr