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About the Gall Bladder Operation or Cholecystectomy - Part Three

Bile duct injury Injury to the bile duct Injury to the main bile duct is the major risk during cholecystectomy. This occurs in about one in every 300 operations so is rare but does need a major operative repair to fix the problem. Surgeons are very aware of this and try very hard to avoid it.

Other problems in the abdomen Other problems inside the abdomen (such as leakage of bile) can occur after cholecystectomy but often do not happen until patients have gone home. Should a patient develop increasing abdominal pain or become jaundiced (yellow coloured skin) at home, then they should consult their own doctor as soon as possible.

Diarrhoea A small percentage of patients notice their bowels become looser after cholecystectomy. This is usually very minor but occasionally medication is needed to control this effect.

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.

The risks of a general anaesthetic General anaesthetics have some risks which may be increased in the presence of chronic medical conditions but are in general:

Common but short term effects (risk of 1 in 10 to 1 in 100) are a feeling of sickness and blurring of vision (which can be treated and usually resolve quickly) and injection site discomfort and bruising.

Infrequent complications (risk of 1 in 100 to 1 in 10,000) include temporary breathing difficulties, muscle pains, headaches, damage to teeth, lips and tongue, sore throat and temporary difficulty speaking.

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.

How to deal with problems A fever or infection discharging from a wound is an acute problem which sometimes presents and patients should initially contact their general practitioner for advice. Referral to the hospital surgeons may be necessary and the doctor will make the necessary calls should this be required. If local urgent medical consultation is not available from their general practitioner then attendance at the local Emergency Department should be sought.

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.

On average PCS occurs after cholecystectomy in about ten to fifteen percent of cases and as the symptoms are often not very severe the medical team should work closely to communicate with the patient so they understand the potential for longer term symptoms and report them when they occur. Careful investigation to establish a secure diagnosis initially is related to avoiding this syndrome.

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