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Gallbladder Surgery – Part 3
Main bile duct injury The greatest risk during cholecystectomy is injury to the main bile duct. Once in every three hundred operations is the typical frequency of this problem. As it requires major surgery to fix this problem all surgeons are acutely aware of it and make every attempt to avoid it.
Other side effects in the abdomen There are other side effects from cholecystectomy such as a leaking of the bile but these are not usually apparent until after discharge of the patient. Patients should consult their general practitioners at once if they develop a yellow colour to the skin (jaundice) or find they are having steadily increasing abdominal pain.
Loose stools A level of diarrhoea can be experienced in a small group of patients who have had a cholecystectomy. Typically this is a minor effect but at times medication is required to control it.
Deep vein thrombosis (DVT) DVT is a possible problem after cholecystectomy but is uncommon. If a patient is at particular risk (having had a thrombosis before or if they are taking the contraceptive pill) then they should tell the surgeon about this and special precautions will be taken to reduce the risk. Moving the legs and feet as soon as possible after the operation and walking about early all help to stop thrombosis occurring.
General anaesthetics ” the risks A general anaesthetic comes with some risks which are usually low but may be more likely in people with other medical diseases:
Temporary side effects which are common (one in ten to one in a hundred risk) are pain and bruising around injection sites, sickness and blurred vision. These settle quickly and can be treated.
Less frequent complications (one in a hundred to one in ten thousand) are temporary difficulties with speaking and breathing, headaches, muscular pains, damage to lips, tongue and teeth and sore throat.
Side effects which are very uncommon but very important with a risk of less than 1 in 10,000 could be long-lasting damage to blood vessels and nerves, failure of the liver or kidneys, injury to the eyes, brain, laryngeal or lung damage, serious allergic reactions and death. These latter side effects are very rare and depend on the other medical conditions the patient has.
The reasons why the laparoscopic technique is preferred The typical surgical technique for gall bladder removal has moved strongly from open operation to laparoscopic management. The main benefits include a lower risk of infection, a reduction in pain post-operatively, quicker time to recovery and a very low scarring level. Patients are fully mobile, independent and able to be discharged home within 24 hours and can return to work by a week from the procedure. Laparoscopic cholecystectomy is now a well established procedure and most surgeons are experienced in this.
What to do if there is a problem? If there is an acute problem such as fever or a discharging wound it is best for patients to contact their own family doctor first. The doctor may suggest the patient sees the surgeons at the hospital and if this is necessary they will make the arrangements. If patients are unable to get urgent medical help from a general practitioner they should attend the Emergency Department of their nearest hospital.
PCS or Postcholecystectomy Syndrome
PCS or postcholecystectomy syndrome includes a series of symptoms such as ongoing symptoms after the operation which were thought to be due to the gallbladder or new symptoms typically classed as related to that organ. There are also symptoms caused by the removal of the organ itself. Changes in bile flow once the gallbladder, normally the bile reservoir, has been removed are thought to cause the difficulties. The upper digestive tract can suffer inflammation of stomach and oesophagus due to increased flow of bile, with the lower tract suffering from colic-like abdominal pains and diarrhoea.
Typical average prevalence of PCS is 10 to 15 percent of cases of cholecystectomy, with attentive communication and questioning required both to explain the potential difficulties pre-operatively and to elicit the somewhat subtle symptoms later. Overall opinion is that the more securely the diagnosis is made initially the less likely PCS is to occur.
About the Author
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physiotherapy, physiotherapists in London, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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