Overview
Plumbing the body's most delicate ducts.
The bile ducts are thin-walled tubes that drain bile from the liver into the small intestine. Damage or disease — from a difficult prior gallbladder operation, a benign stricture, a cyst, or a cancer — disrupts that drainage and produces jaundice and infection. Repairing the bile ducts is some of the most technically demanding work in general surgery. It is best done electively, after thorough imaging, by surgeons who do this work regularly.
Our bile duct operations span the spectrum: hepaticojejunostomy (a Roux-en-Y reconstruction connecting the upper bile duct to a loop of small intestine) for injuries and strictures, choledochal cyst excision with reconstruction in adults, and major resections for cholangiocarcinoma. Every case is reviewed against high-quality MRCP or contrast imaging — sometimes with assistance from interventional radiology or gastroenterology — so the operative plan matches the anatomy.
Who is a candidate?
Most patients with bile duct injury, stricture, or cancer are candidates for repair. Timing is important: bile duct injuries are best repaired after acute inflammation has resolved (often 6–8 weeks after the original operation) and with biliary drainage controlled. Choledochal cysts in adults should be excised because of the long-term cancer risk. Cholangiocarcinoma resection is offered when the tumor is resectable on imaging and the patient is fit for major surgery, ideally after multidisciplinary review.
How we perform it
Open surgery is the standard for most bile duct reconstructions. The operation is performed under general anesthesia through an upper-abdominal incision. The diseased segment of the duct is removed, and the remaining healthy duct is connected to a loop of small intestine (Roux-en-Y hepaticojejunostomy) to restore bile drainage. For cholangiocarcinoma, the operation often includes liver resection or pancreatic surgery depending on tumor location. Minimally invasive approaches are used selectively. Operations range from 3 to 8 hours.
Recovery
Hospital stay is typically 5–10 days. Drains stay in for 1–2 weeks while we watch for any biliary leak. At home, recovery is gradual over 4–6 weeks. Some patients require pancreatic enzymes or temporary medication to manage bile salt malabsorption. Follow-up imaging is at 6 weeks, 3 months, and then on a schedule appropriate to the underlying disease.
Why Florida Surgical
Bile duct surgery is unforgiving — leaks, strictures, and recurrent infections are devastating, and most can be prevented by careful technique and good preoperative planning. Dr. Shaw is fellowship-trained in surgical oncology with focused experience in hepatobiliary surgery. We coordinate with gastroenterology and interventional radiology before and after the operation so that biliary drainage is optimized, imaging is comprehensive, and patients are well prepared.
Frequently asked questions
How do bile duct injuries happen?
Most bile duct injuries occur during a difficult gallbladder operation — usually when inflammation or anatomy makes the duct hard to identify. Modern techniques (the critical view of safety, intraoperative imaging) make injury much less common than in the past.
Will I need a stent or external drain after surgery?
Many patients have a small external drain in place for one to two weeks after surgery to monitor for biliary leak. Internal stents are sometimes used inside the reconstruction for the first few months; they are usually removed via endoscopy.
Can a choledochal cyst be left alone?
Not in adults. Choledochal cysts carry a significant long-term risk of bile duct cancer and should be excised electively. The risk of cancer is one of the strongest indications for resection.
Is cholangiocarcinoma curable with surgery?
For localized cholangiocarcinomas removed with negative margins, 5-year survival rates range from 25 to 50 percent depending on stage and tumor location. Surgery offers the only realistic chance at cure, often combined with chemotherapy.
What's the difference between this and a Whipple?
A Whipple is the operation for cancers at the head of the pancreas and the very lowest portion of the bile duct. Bile duct cancers higher up the tree (perihilar, intrahepatic) require different operations — sometimes a liver resection, sometimes a hepaticojejunostomy alone. We choose the right operation based on tumor location.