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Operations to Treat Tumors of the Bile Duct

This information describes the surgeries to remove tumors of the bile duct and the possible side effects.

Introduction

This booklet describes the operations that are commonly done to remove tumors of the bile duct. Your doctor and nurse will discuss your diagnosis and specific treatment with you in more detail. Please share your questions and concerns with them.

About the Bile Duct

Figure 1: The liver and bile duct system Figure 1: The liver and bile duct system Bile helps to digest food. A bile duct is a channel that carries bile from the liver and gallbladder into the small intestine. (See Figure 1.) Throughout the liver there are thousands of small bile ducts, similar to branches on a tree. Bile, which is made by liver cells, empties into these small ducts. The ducts merge within the liver, forming progressively larger bile ducts. These eventually join to form the right and left hepatic ducts.

The right and left hepatic ducts exit from the liver and connect to form the common hepatic duct. (See Figure 1.) It is then joined by the cystic duct from the gallbladder to form the common bile duct. The cystic duct allows bile to pass into and out of the gallbladder. Some bile is stored in the gallbladder. The bile flows from the liver and the gallbladder and empties into the first portion of the small intestine (the duodenum).

If a tumor or mass blocks your bile duct, the bile does not empty into the duodenum. Instead, it is absorbed into the bloodstream. Symptoms of a blocked bile duct are yellow skin color (jaundice), itching, pale-colored stools, and dark (tea-colored) urine. Your doctors may have inserted a stent (a plastic or metal tube) into the bile duct to help relieve jaundice. The tube may restore the normal flow of bile, but it does not treat the underlying problem. An operation on the bile duct is done to remove a tumor blocking the flow of bile.

Preparing For Your Operation

Your nurse will give you the instructions you need to prepare for your operation. You will also get a booklet called “Getting Ready for Surgery”. Aspirin and ibuprofen can cause bleeding problems. Do not take medicine that has them unless your doctor says it is okay. Your nurse will give you a fact card that tells you what drugs you can and cannot take.

The Operation

Figure 2: Possible locations of bile-duct tumors Figure 2: Possible locations of bile-duct tumors The operation that you will have depends on the size and location of the tumor in your bile duct. This will be determined by your surgeon at the time of the operation. Tumors that are high in the bile duct are closer to the liver. Low bile-duct tumors are closer to the duodenum and pancreas. Your surgeon can use the illustration in this booklet to show you the approximate location of the tumor in your bile duct. (See Figure 2.)

The operations commonly done to remove tumors of the bile duct are:

  • Bile-duct excision for high bile-duct tumors with reconstruction and liver resection.

In order to remove the entire tumor, the common bile duct and the gallbladder are removed. Your body will function normally without your gallbladder. The surgeon attaches a piece of your small intestine to the remnant of the bile duct. This allows the bile to flow directly from the liver into the small intestines. Sometimes, the tumor involves the liver. If it does, your surgeon will take out a piece of the liver. You may be given a booklet about a liver resection.

  • Bile-duct excision with reconstruction for mid to high bile-duct tumors.

To take out all of tumor, the common bile duct is removed. The surgeon attaches a piece of your small intestine to the remnant of the bile duct. This allows the bile to flow directly from the liver into the small intestines. Your surgeon may also need to take out a piece of your liver, pancreas, gallbladder, and small intestine. Your nurse will give you copies of the booklet about this operation if it is possible that you will have it.

  • Bile-duct excision for low bile-duct tumors with possible Whipple procedure.

To remove the tumor, the head of the pancreas, the duodenum, the end of the common bile duct, and the gallbladder are removed. A small portion of your stomach may also be removed. If you are having this operation, your nurse will also give you the Whipple procedure booklet.

  • Biliary enteric bypass.

This procedure is done when the tumor cannot be removed. The surgeon attaches a piece of your small intestine directly to the bile duct. This allows the bile to bypass the tumor and flow from your liver to your small intestine.

On average, these operations take 3 to 5  hours. The usual hospital stay for any of these procedures is about 7 to 10 days.

After Your Operation

After your procedure, you will wake up in the Post-Anesthesia Care Unit (PACU). You may spend the first night there. When you wake up after the operation you will most likely have the following:

  • A nasogastric (NG) tube. It is inserted through your nose into your stomach. It drains secretions from your stomach and allows your stomach and intestines time to heal. The tube is usually removed on the first or second day after the operation.
  • A soft catheter to drain urine from your bladder. The catheter is usually taken out on the second or third day after the operation.
  • An intravenous (IV) line to give you fluids and medicine until you begin to eat and drink liquids again. It is usually placed in your neck or arm.
  • Compression boots on your legs. These boots help maintain circulation in your legs. They gently squeeze and relax your calves to help prevent blood clots from forming. They will be removed when you are walking or when you no longer need them.
  • A biliary drainage tube to drain bile. The tube is usually taken out a few days after your operation, but some patients may go home with it still in place. If you go home with the tube, your case manager will arrange for a visiting nurse to help you care for it at home.

Pain Control

You will have a patient-controlled analgesia (PCA) pump connected to your IV line. The pump allows you to safely give yourself prescribed doses of medication when you need to relieve pain. The nurses will teach you how to use the PCA pump. Please speak to your nurse, doctor, or both, if you do not have adequate pain relief. When you resume your regular diet, your IV line will be removed and you will be switched to pain medication by mouth.

It is very important that your pain is controlled enough so that you can walk, cough, and breathe deeply. The compression boots will be removed once you are able to walk. You will be helped out of bed to a chair. A short time later, you will walk a short distance with help. Walking soon after the operation helps improve circulation, reduces the risk of blood clots, and stimulates your bowels. You will also be asked to do coughing and deep breathing exercises and to use the incentive spirometer. These help to prevent pneumonia.

Your Diet

Once your bowels begin to work again, you will be able to drink sips of clear liquids. You will gradually advance to a regular diet. Your diet will not have to change after the operation. Many patients lose weight before the operation but you will regain the weight slowly as your appetite improves. Also, patients often gain weight right after surgery because their body holds on to water for a few days afterwards.

Going Home

When you are eating a regular diet, moving your bowels, and show no signs of complications, you will be ready to go home. Your doctor or nurse will give you instructions and prescriptions for any medications that you need. Your nurse will review these instructions with you and give you a copy to keep. If you need a visiting nurse at home, arrangements will be made before you are sent home.

Special Instructions

Please follow the special instructions below as you continue to recover at home.

Fatigue

A common complaint for up to 6 to 8 weeks after the operation is fatigue. Some of this fatigue is because of the procedure, and some is because of the weight you may have lost before the operation. This will slowly improve over time. Try to increase your activity level every day to help your fatigue. Get up, get dressed, and walk. Gradually increase the distance you walk each day. If necessary, you may take a nap during the day. However, try to stay out of bed as much as possible so you will sleep at night. Your nurse will give you the booklet, “Handling Fatigue During and After Cancer Treatment.

Pain

At home, you may still have some pain along the incision that requires medication. Take it as prescribed. As the pain lessens, extra strength acetaminophen (Tylenol® Extra Strength) may be enough to control it.

Constipation

Pain medicines can be constipating. To help prevent this, drink extra fluids and eat foods high in fiber. You will also be given a prescription for Colace®, a stool softener. Take it as directed by your physician while you are using pain medications. If you become constipated, take two Senokot® tablets at bedtime or increase the number of Colace® you are taking.

Incision Care

Keep your incision clean by showering each day. Use regular soap.

Activity

Light exercise will help you gain strength and feel better. We recommend walking. Check with your doctor or nurse before doing anything more strenuous. You may walk up stairs, but in the beginning try not to overexert yourself. For 6 weeks after the operation do not lift anything heavier than 10 pounds. You may resume driving when your doctor permits it, usually about three weeks after the operation. Do not drive if you are taking pain medicine. They can make you drowsy. We also recommend that you do exercises that help you to stretch the incision. They also work on the muscles that have been cut during surgery. Stand in place and slowly lean backward. This stretches the abdominal incision. Return to a straightened position and lean over to one side. Then lean to the other side. Repeat this exercises a few times a day. They will help to reduce any discomfort from the surgery.

Conclusion

In general, the first follow-up visit with the doctor will be 10 to 14 days after you are sent home. Call your doctor's office to schedule the appointment. Your follow-up visit is a good time to tell your doctor and nurse how you are progressing. You can also discuss any questions or concerns that have come up since you were sent home.

Call Your Doctor or Nurse If you Have:

  • Chills
  • A fever of 101° F (38.3° C) or higher
  • Jaundice (yellow skin or eyes)
  • Itching
  • Redness or drainage from your incision
  • Any sudden increase in pain or new pain
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation that is not relieved within 2 or 3 days
  • Any new or unexplained symptom
  • Any questions or concerns