SURGERY!! “What For?”

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August 15, 2013 by greenhouse04

For what am I having surgery anyway?

If you saw me you’d see that I’m certainly not sick. In fact, I feel great.

But there’s something (another thing!) wrong in my body that needs fixed: my common bile duct.

I didn’t know this until a couple of months ago, but the common bile duct is the main duct that goes from your liver to your intestines, carrying away the bile. The duct is supposed to be really skinny. Mine is like a small balloon – more than double the normal size.

This isn’t really a problem right now. It’s largly asymptomatic – it doesn’t cause illness or pain. It’s not the cause of gallstones. The bile can usually get through ok.

While it’s not a problem right now, it could easily cause a big problem in the future. The surgeon I spoke to says I could have as high as a 50% chance of developing cancer in that duct by the time I’m 50 if it’s not removed. He said it was virtually certain I’d develop cancer in it sometime by the time I’m 90, if nothing else kills me. And common bile duct cancer would not be pretty, since it’s connected to the liver, pancreas, and intestines.

So, it needs to be removed. Not only removed, however (since it’s kinda indispensable) but replaced. It will be replaced with a length of small intestine. The surgery is technically called a Roux-en-Y hepaticojejunostomy. “Roux-en-Y” means “Y in the road” in french. It’s called this because the new duct made from the small intestine forms something that looks like a y, bypassing the pancreas around to the intestine.

Here are a few other fun facts about this condition:

  • It’s techinically called a Choledochal cyst, even though its not really a cyst.
  • It happens 80% of the time in young children as a birth defect.
  • In adults, it happens mostly in women and Asians.
  • The above is very ironic to me as I lived in China for a year and have a Chinese sister-in-law.
  • In western countries it is very rare, and in the U.S. is on the “rare disease” list.
  • No one knows why it develops or why it causes cancer.

There are a few things that I could worry about with this surgery. For one, my duct is enlarged all the way down, even where it passes through the pancreas (which is unusual). However, the surgeon can’t dig it out of the pancreas completely, so he’ll have to remove as much of the lining as possible.

Second, the surgeon isn’t sure about the state of the small ducts branching off into my liver, or of my liver itself. He didn’t say what he’d do if the smaller ducts are also enlarged – he reassured me that this isn’t likely. However, many of these conditions are already highly unlikely so that’s not very reassuring! And if something’s damaged in the liver, he warned that he may have to remove part of it. I don’t know what all that would entail, but sounds fun!

Finally, during our consultation he said that it’s “highly unlikely that there would be any cancer cells” in the duct yet, since my gallbladder was clean back in April when it was removed. Hmmm, that says to me that there is a chance, however small, of cancer already being there.

But hey, I’ll cross all those bridges when I get to them. I could spend my time worrying about more likely complications, like bowel obstructions or leaks due to all the cutting into the intestines they have to do.

My next post will be about worry, by the way. 🙂

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