Are There Long Term Complications For A Cholecystectomy?

Cholecystectomy, that is removal of the gallbladder, is usually considered a safe operation, however there is a small risk of complications associated as is with all procedures. Most of the complications and risks carried by cholecystectomy are minimal and can be reversed or fixed. Long term complications are minimal, but very detailed in nature. 

The most serious complication that is encountered during and after the cholecystectomy is damage inflicted to the bile ducts. This occurs very rarely but when it does, it is taken very seriously.

This damage will be characterized by certain symptoms. These will include;

• Abdominal pain
• Fever
• Swelling
• Redness
• Jaundice (yellowing of the eyes and skin)

The treatment of this damage type is usually dependent on the degree of severity of the complication. The methods of treatment include biliary stenting which is basically insertion of an anatomic vessel or duct to keep internal body passageways open.

There is also the surgical construction of Roux-en-Y which entails the building of an end to end duct that will be used to drain bile away or ensure that the duct is kept open and channeled correctly.

The effects that result from the leaking of the bile juice or damage of the bile ducts are:

• Hernias or swelling of the skin in pronounced lumps that are clearly visible.
• Internal bleeding 
• Internal and external infection. Internal infection is characterized by pains that don’t cease and external injuries produce pus from the incision wound.
• Damaging of the liver which when touched by the juice is as susceptible as the stomach.
• Biloma (bile leak)

The complications involving the bile ducts are specific and detailed. Below is an outline of postoperative cystic duct stump leaks.

Postoperative Cystic Duct Stump Leaks

This is a leak that develops right after the cholecystectomy is done. However, since the advent of the laparoscopic cholecystectomy, the incident of this occurring is reduced to miniscule percentages.

There are ways to explain why this happens:

• Cystic Dump Displacement
  When the operation is done, there are clips placed at the cystic stump. If not placed correctly, they can result in this condition. Cystic duct displacement could also be as a result of your internal body features around the area being different and hard to really know where to place the clips after the operation is done. This places obstacles that lead to improper firing.

  The solution for this however is simple and effective. One could have the duct sutured or insertion of t-tube could be done. It’s also called a Jackson Pratt drain.

• Proximity of Cystic Dump To The Clips
  When the clips are placed near the cystic dump, there might be electrocautery. When this happens, there is coupling together of the clips. As electrocautery is conducted through clips which are metal, it may cause what is known as necrosis.

  Necrosis is formation of gangrene of the bones. It also forms where there is arterial obstruction and is characterized by brown and dry dead tissue. Electrocautery, on the other hand, is application of a needle heated by electric current to destroy tissue.

  These processes occur together to cause the gangrenous problems that are a spawn of putting so many clips together.

• Heart Failure or Disrupted Blood Flow
  During the operation, blood flow can be disrupted from dissecting. There have been studies which have shown that a widening of the arterial walls into sac-like structures happens. These result from weakening of the arterial walls, which could lead to vascular disruption of the blood supply to the cystic duct.

  However, there is a solution for this problem. One has to divide the cystic artery far from the midline of the artery itself. It is therefore divided around the edges and far away from the middle.

• Increased Biliary Pressure
  Despite the fact that this kind of cause for bile leaks or damaging is rare, it has happened. When a bile duct stone is retained, it causes pressure in the biliary tree. This increases the chances of one getting cystic duct stump leaks.

Symptoms of Cystic Duct Displacement

Going on further about the Cystic Duct Displacement, we examine its symptoms and how it manifests.

After about 3 or 4 days after the surgery is done, there will be feelings of sickness, wanting to vomit and pain. The abdomen pain is persistent and continuous. It is closely followed by nausea, vomiting and the fever.

Liver functions vary from one person to another and the intensity or lessened activity from patient to patient is different.

Treatment of Cystic Duct Displacement

There is a test called an ultrasonography test that is used to screen and test for Biloma, ascites and stones that may have been retained. Computed tomography is used to check for any unusual shapes and swelling. This method is accurate as it uses X-rays to construct a 3-dimensional map of the body. The success rate for the tomography to detect anything amiss is very high.

After the problem has been detected, the necessary and recommended ways to fix it are used and nowadays, one does not even require re-operation because of endoscopic draining.

Other Complications and How They Relate

• Injury to the organs near the Gallbladder
  The instruments used in the procedure can sometimes harm the surrounding organs that are located around the gallbladder. These might include intestines, blood vessels and even the bowels. This happens if the gallbladder has been inflamed and hence attached itself to the surrounding organs, making the operation tricky.

  There are no long term implications for this if one goes back to the hospital for immediate rectification, but if ignored or smothered by pain medicines, the situation could easily go south in the most unexpected of ways.

  When bile goes where it is not supposed to go, it is basically your body poisoning itself.

Bottom Line

It is imperative that when such complications occur, you get back to the surgeon or doctors that performed the operation. They can help delay the onset of gangrene which is just a medical term for rotting on the inside. Dying of tissue causes other complications and if the organs are in any way harmed, have them checked.