Complex biliary surgery refers to a set of intricate surgical procedures performed on the biliary system, which includes the gallbladder, bile ducts, and the liver.

These operations are necessary for the treatment of various complex and severe conditions affecting the biliary tract, such as biliary strictures, bile duct injuries, biliary tumors such as hilar cholangiocarcinoma (Klatskin tumours) and other complex biliary disorders.

Some types of Complex Biliary Surgery


Biliary reconstruction

This involves the surgical repair or reconstruction of the bile ducts and can be necessary in cases of injury (e.g. after cholecystectomy), stricture, or chronic blockage. Biliary reconstruction aims to restore the normal flow of bile from the liver to the small intestine. Biliary reconstruction can sometimes be required in combination with liver resection


Liver resection

Depending on the level of biliary involvement (e.g. for biliary problems situated within the liver itself or just outside the liver (hilar pathology), formal liver resection can be required. This can be necessary as the bile ducts draining a particular portion of the liver are diseased.


Liver transplantation

In cases of end-stage liver disease or certain types of liver cancer, a liver transplant may be necessary. This complex procedure involves the surgical replacement of a diseased liver with a healthy liver from a donor. This procedure is only performed in the public hospital in New Zealand.


Risks and complications

Major biliary surgery is complex and often performed in elderly individuals with cancer. Risks include –

  • Death
  • Need for urgent procedures after surgery
  • Liver failure
  • Leakage from the liver or bile ducts
  • Bleeding
  • Infection
  • Digestive symptoms
  • Medical problems from the stress of surgery such as heart attack, pneumonia, blood clots


The risks of surgery and how they apply to each patient are usually discussed during any consultation when surgery is planned and again when consent for surgery is obtained.


Recovery after surgery

Recovery from surgery depends on the magnitude of the operation and the overall health of the patient. Most people can be in hospital for around a week. Patients sometimes go home with a drain in to prevent a late infection and can have a gradual recovery when at home to get back to their usual energy levels and activities. If surgery is required for cancer, patients can also require chemotherapy which affects their recovery.


Follow-Up Care 

Following complex biliary surgery, regular follow-up visits with a healthcare provider are crucial. These visits are important for monitoring the recovery process, managing any complications, and ensuring that the biliary system is functioning properly.

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