RT Book, Section A1 Haisley, Kelly R. A1 Hunter, John G. A2 Brunicardi, F. Charles A2 Andersen, Dana K. A2 Billiar, Timothy R. A2 Dunn, David L. A2 Kao, Lillian S. A2 Hunter, John G. A2 Matthews, Jeffrey B. A2 Pollock, Raphael E. SR Print(0) ID 1164319030 T1 Gallbladder and the Extrahepatic Biliary System T2 Schwartz's Principles of Surgery, 11e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259835353 LK accesssurgery.mhmedical.com/content.aspx?aid=1164319030 RD 2024/10/09 AB Key Points The physiology of the gallbladder, biliary tree, and sphincter of Oddi are regulated by a complex interplay of hormones and neuronal inputs designed to coordinate bile release with food consumption. Dysfunctions related to this activity are linked to the development of gallbladder pathologies as described in this chapter. In Western countries, the most common type of gallstones are cholesterol stones. The pathogenesis of these stones relates to supersaturation of bile with cholesterol and subsequent precipitation. Laparoscopic cholecystectomy has been demonstrated to be safe and effective, and it has become the treatment of choice for symptomatic gallstones. Knowledge of the various anatomic anomalies of the cystic duct and artery is critical in guiding the dissection of these structures and avoiding injury to the common bile duct during cholecystectomy. Common bile duct injuries, although uncommon, can be devastating to patients. Proper exposure of the hepatocystic (Calot’s) triangle to obtain the critical view of safety and careful identification of the anatomic structures are keys to avoiding these injuries. Once a bile duct injury is diagnosed, the best outcomes are seen at large referral centers with experienced biliary surgeons, and patient transfer may be required. The main risk factor for gallbladder disease in Western countries is cholelithiasis. The main complications include cholecystitis, choledocholithiasis, cholangitis, and biliary pancreatitis. Cholelithiasis is also the major risk factor for the development of gallbladder cancer. Carcinomas of the gallbladder or bile ducts generally have a poor prognosis because patients usually present late in the disease process and have poor response to chemotherapy and radiation. Surgery offers the best chance for survival and has good long-term outcomes in patients with early-stage disease.