The present status of biliary tract surgery

The techniques now routinely available for modern biliary tract diagnosis and treatment have allowed today's biliary surgeon to make a diagnosis more rapidly and with greater delineation of the pathology than a decade ago. As well, the extension of these diagnostic techniques has allowed interventional procedures to be carried out by both the radiologist and the endoscopist such that certain palliative procedures may now be done without laparotomy, and reoperations may be avoided by percutaneous or endoscopic approaches. Operative surgery in this area has not had the same spectacular advances. Rather there have been refinements and additions to previously used techniques that have standardized the procedures. Moreover, surgery has benefited from the technologies that have allowed the better preparation of the patient by the percutaneous or endoscopic relief of jaundice before an operation, the disimpaction of stones in cholangitis, and papillotomy in acute pancreatitis. The availability to the surgeon of the extremely slim flexible endoscope has made biliary endoscopy at operation simpler as well as providing a tool for percutaneous biliary endoscopy and stone extraction. In the same era, tests that were among the most common for diagnoses such as the oral cholecystogram and intravenous cholangiogram have become infrequent and perhaps obsolete. It has become obvious that the complete biliary surgeon must now have available isotopic, sonographic, and radiologic imaging, endoscopy, and other equipment not even imagined by those who pioneered biliary surgery.