LIVER AND BILIARY TRACT SURGERY

Cholecystectomy (gallbladder removal) is one of the most common surgeries performed in surgical wards. About 80,000 procedures are carried out in Italy every year. The indication is usually gallstone disease and its complications. The international Gold Standard for surgical treatment is laparoscopic cholecystectomy, though in some (rare) cases, an open procedure is necessary. In a small but significant percentage (10-15%) of gallstone cases, there may also be common bile duct stones, sometimes accompanied by severe symptoms (jaundice and cholangitis). In such cases, cholecystectomy can be performed after endoscopic treatment of the common bile duct stones. However, in public and private hospitals where an experienced endoscopist and appropriate technology are available, it is possible to perform both cholecystectomy and intraoperative ERCP (rendezvous technique). The benefits for the patient are undeniable with a one-stage therapy, resulting in faster recovery and reduced costs. Other biliary tract conditions (tumors, inflammation, or malformations) may also require surgery. Benign liver tumors are rarely operated on unless symptoms related to size or location are present. More commonly, surgeries involve removing part of the liver (sometimes complex procedures) for primary malignant tumors (hepatocellular carcinomas arising from cirrhosis, biliary tract tumors). For about 20 years, liver resection has also been indicated for liver metastases from tumors originating in other areas (e.g., colorectal cancer). In these cases, surgery is often combined with complementary treatments (chemotherapy) or radiological procedures (e.g., thermoablations, percutaneous chemoembolizations). Surgical interventions range from more or less extensive hepatectomies, depending on the number, location, and patient characteristics. These surgeries should be performed by an experienced surgeon and team, guided by intraoperative ultrasound to improve the quality and radicality of the procedure. This type of surgery can be performed using open surgery as well as minimally invasive techniques (laparoscopic or robotic surgery).