Continued Complaints Following Cholecystectomy

The causes of continued upper abdominal complaints following cholecystectomy are illustrated in this exhibit. An understanding of the normal biliary mechanism and the physiologic alteration with disease facilitates the surgical approach to biliary tract disease. It is apparent that radiography, both preoperatively and on the operating table, plays a vital role in diagnosis.

Physiology  Bile is secreted by the liver cells at a maximum pressure of 300 mm. of water. As the sphincter of Oddi is normally closed, hepatic bile passes into the gallbladder, where it is concentrated and stored. Water and salts are absorbed by the gallbladder wall, and a small amount of mucin is secreted. The normal gallbladder, because of its distensibility, acts as a safety valve against elevated intraductal pressure. The kinetics of the entire biliary tract depend upon the bile flow control of the sphincter of Oddi and the "pressure bulb" function of the gallbladder (Fig.