Changes

Intraluminal obstructions such as choleliths can be removed surgically via a '''cholecystotomy''' (incision into the gall bladder) but, if stone is within the common bile duct and this is very dilated, a '''choledochotomy''' can be performed.  Alternatively, the duodenal papilla can be catheterised and the cholelith can be flushed back into the gall bladder.  If the duct is not dilated, strictures may occur if a choledochotomy is performed and the procedure is associated with higher rates of mortality in humans.  The abdomen is entered via a midline coeliotomy and the gall bladder is exposed in its normal position between the quadrate and right medial lobes of the liver.  A needle is inserted to aspirate bile (using a syringe or suction) and stay sutures are placed in the infundibulum and fundus of the gall bladder.  The incision is made between these sutures and, after removal of any obstruction, it is closed with an inverting suture pattern.  In cases of recurrent cholelithiasis, '''cholecystectomy''' is recommended.  This involves mobilisation of the gall bladder from its fossa and ligation of the cystic duct and cystic artery with transfixing ligatures.

Intraluminal obstructions such as choleliths can be removed surgically via a '''cholecystotomy''' (incision into the gall bladder) but, if stone is within the common bile duct and this is very dilated, a '''choledochotomy''' can be performed.  Alternatively, the duodenal papilla can be catheterised and the cholelith can be flushed back into the gall bladder.  If the duct is not dilated, strictures may occur if a choledochotomy is performed and the procedure is associated with higher rates of mortality in humans.  The abdomen is entered via a midline coeliotomy and the gall bladder is exposed in its normal position between the quadrate and right medial lobes of the liver.  A needle is inserted to aspirate bile (using a syringe or suction) and stay sutures are placed in the infundibulum and fundus of the gall bladder.  The incision is made between these sutures and, after removal of any obstruction, it is closed with an inverting suture pattern.  In cases of recurrent cholelithiasis, '''cholecystectomy''' is recommended.  This involves mobilisation of the gall bladder from its fossa and ligation of the cystic duct and cystic artery with transfixing ligatures.

Palliative surgical intervention may be undertaken in cases with large masses the involve the biliary tract.  In these cases, biliary re-routing procedures such as '''cholecystoduodenostomy''' or '''cholcystojejunostomy''' may be considered, where a stoma is created directly between the gall bladder and duodenum or jejunum, respectively.  Cholejejunostomy is easier to perform as a loop of jejunum may be brought to the gall bladder but this results in discharge of bile further down the gastro-intestinal tract.  It is highly advisable to refer animals to a specialist centre for any biliary tract surgery.  

Palliative surgical intervention may be undertaken in cases with large masses that involve the biliary tract.  In these cases, biliary re-routing procedures such as '''cholecystoduodenostomy''' or '''cholcystojejunostomy''' may be considered, where a stoma is created directly between the gall bladder and duodenum or jejunum, respectively.  Cholejejunostomy is easier to perform as a loop of jejunum may be brought to the gall bladder but this results in discharge of bile further down the gastro-intestinal tract.  It is highly advisable to refer animals to a specialist centre for any biliary tract surgery.

 

==Prognosis==

==Prognosis==

The prognosis depends on the cause of the obstruction but affected animals are often very ill.   

The prognosis depends on the cause of the obstruction but affected animals are often very ill.