Cholecystectomy or removal of the gallbladder is one of the most common surgical procedures performed.

Indications for surgery include benign disease such as acute cholecystitis, chronic cholecystitis or biliary dyskinesia.

Another indication for cholecystectomy would be the presence of “gallbladder polyps” if they meet certain size criteria.

Though rare, certain patients do present with a “gallbladder mass” or malignancy or are diagnosed with gallbladder cancer in pathology review after undergoing a cholecystectomy.

Depending on imaging and pathology findings certain patients may need additional resection of liver or bile duct margins and also removal of the local lymph nodes.

The same principles apply to surgery of the bile duct. Patients may have “stricture” of the bile duct in both benign and malignant conditions.

Unlike gallbladder disease, most bile duct strictures are due to underlying malignancy. For benign conditions if endoscopic procedures are not successful, surgical approach can include resecting or simply bypassing the bile duct.

For malignant disease, the procedure would require resecting the bile duct with the goal of achieving negative margins, usually along with resection of the lymph nodes.

Subsequently the bile duct will be “reconstructed” by bringing up a part of the small bowel to create an anastomosis.