Complications of Laparoscopic Gallbladder Surgery

Gallbladder surgery, also known as cholecystectomy, is the most common operation performed in North America. More than half a million people in the United States and approximately 50,000 in Canada have their gallbladders removed every year. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first-choice option of gallbladder removal.

How the Gallbladder Works

• The gallbladder is located beneath the right side of the liver. The gallbladder collects bile, which is produced by the liver. The gallbladder squeezes bile into the small intestine when food is eaten; more bile is released with fatty foods. The bile travels through narrow bile ducts into the small intestine. Gallstones are small hard masses of cholesterol and bile salts that form in the gallbladder. Pain occurs when a gallstone blocks the flow of bile in the duct.

Laparoscopic Surgery

• Under general anesthesia, the surgeon creates four small openings in the abdomen. Cannulas, narrow tube-like instruments, are inserted into the openings. A laparoscope, which is similar to a small telescope with a camera, is inserted into the cannula. The cameras allows the surgeon to see a magnified view of the gallbladder on a television screen. The surgeon carefully separates the gallbladder and removes it through an opening. Additionally, if stones are in the common bile duct, the surgeon may remove them as well.

Reducing Complications

• The single most important aspect of ensuring a successful laparoscopic gallbladder surgery is the expertise of the surgeon. The National Institute of Health (NIH) has endorsed laparoscopic surgery as a safe surgical treatment, noting that it is equal in efficacy to the traditional open surgery. However, it warns that it should only be performed by experienced surgeons.

Abandoned Laparoscopic Surgery

• Several factors can cause a surgeon to decide to abandon laparoscopic surgery and undertake traditional open surgery. Abdominal peritoneal adhesions are one such problem. The presence of gangrene, also, will necessitate a switch. Situations where the view is obscured will cause a change, as well; this is more prevalent in obese patients. A switch to open surgery is not technically considered a complication in the literature.

Injury to the Bile Duct

• Cutting or nicking the wrong bile duct is the most common serious error. The bile ducts are very thin, small ducts that are close to each other. Since every person's anatomy is different, it is critical that the surgeon properly identifies and cuts the correct ones. The consequence of cutting or nicking an incorrect one is that bile will seep into the abdominal cavity and poison the patient. Depending on the severity of the injury, additional surgeries may be needed to correct this complication. Symptoms may initially present themselves when the patient indicates he isn't feeling well. Jaundice can also be a symptom. Pain and breathing difficulties may eventually occur, as can death if left untreated.

Cancer

• Two types of cancer are more prevalent in individuals who have had their gallbladder removed. The first is colon cancer. In many patients the constant dripping of bile causes the irritation of the large intestine. This causes diarrhea, and the long-term effect of all of this irritation is colon cancer. This type of cancer normally occurs on the right side of the colon.

  Another study from the University of Southern California has shown that patients who had a cholecystectomy were at a significantly higher risk for pancreatic cancer.

Other Complications

• Like all surgeries, laparoscopic surgery has the potential of complications from anesthesia and infections. There can be bleeding, pneumonia, blood clots and heart problems. Up to 40 percent of patients complain of some type of gastrointestinal pain months and even years after surgery. These symptoms include chronic diarrhea, excess bowel gas and a constant pain in the upper right portion of their abdomen