Gallbladder Removal Surgery Complications and Side Effects

Complications of Gallbladder Surgery

A surgical complication is any unanticipated problem that is following and is a result of a surgical procedure.

Complications of gallbladder removal surgery are relatively rare; they occur in about 8% of open and 2% of laparoscopic surgeries ^[7,10]. Old age, obesity, smoking, heavy alcohol drinking, gallbladder inflammation (cholecystitis), liver cirrhosis, coronary heart disease, diabetes mellitus and impaired immunity increase the risk of complications ^[10,13].

The collective medical term for complications and side effects of gallbladder removal is postcholecystectomy syndrome ^[15].

Complications During Surgery

A bile duct injury also usually occurs accidentally. A surgeon may become aware of the injury during the procedure and repair it ^[10].

Anaphylaxis is a severe allergic reaction to drugs and substances used for anesthesia during surgery. Rarely, anaphylaxis can result in heart attack or death ^[8].

Death occurs in less than 1% of open and less than 0.1% of laparoscopic gallbladder surgeries ^[7].

Complications Within Several Days After Surgery

Bleeding from a surgical wound can occur within several days after gallbladder removal. The bleeding wound may need to be opened and sutured again. Bleeding into the abdominal cavity, which can cause abdominal pain and anemia with paleness, shortness of breath and tiredness, may require laparoscopic or open surgery ^[9,10].

Surgical wound infection appears as redness, swelling, pain, tenderness or thick discharge from the wound, usually within 30 days of surgery ^[12]. Treatment can include opening and cleaning the wound and antibiotics.

Inflammation of the membrane that covers the abdominal organs (peritonitis) can cause abdominal pain and tenderness, fever, nausea and diarrhea. Peritonitis can develop after an accidental rupture of an inflamed gallbladder or cut of the bile duct or intestine during surgery.

Urinary tract infection with burning urination and cloudy urine can arise from the urinary catheter inserted into the urethra during surgery ^[7].

Pneumonia can develop due to bacteria from the mouth entering the lungs through a tube inserted into the throat to assist breathing during surgery. Symptoms can include coughing up mucus, shortness of breath and fever.

Bile leakage into the abdominal cavity can cause abdominal pain appearing several days or even months after surgery. Bile leak may stop spontaneously, and if not, it can be treated by various endoscopic or surgical procedures ^[10].

Retained gallstones or strictures (scars) in the bile duct can cause the bile duct inflammation (cholangitis) with right upper abdominal pain, gray stools, fever and jaundice several days to months after surgery ^[6].

Acute inflammation of the pancreas (pancreatitis) can cause middle upper abdominal and middle back pain, fever and nausea within several days to months of surgery ^[18].

Acute kidney failure results in decreased or absent urination, leg swelling, fatigue and nausea ^[14]. This life-threatening condition can develop within a couple of days after surgery, mainly in individuals with preexisting kidney problems.

Individuals prone to deep vein thrombosis may develop blood clots in the legs after surgery. The affected lower leg may be painful, tender to touch, swollen or bluish. The risk of clots increases with the duration of surgery and bed rest. The clots may dislodge and travel to the lungs and can cause a life-threatening blockage of the lung arteries (pulmonary embolism) with sudden cough, shortness of breath and chest pain ^[10].

Late Complications

An abdominal hernia is a soft painful or painless lump due to the protrusion of the small intestine through the abdominal wall muscles at the site of the surgical wound. A hernia most commonly develops in obese individuals after open surgery ^[10].

Hypertrophic scars or keloids grow excessively for several weeks and then either remain raised or shrink with time ^[11].

Adhesions are internal scars that commonly develop at the site of the removed gallbladder. They can cause abdominal pain appearing months or years after surgery. They can be detected and removed during a laparoscopic (endoscopic) investigation of the abdomen.

Loss of sensation around the surgical wound can occur due to a nerve damage. Numbness can persist for several days or months or can become permanent ^[13].

Side Effects of Gallbladder Removal

Side effects of gallbladder removal include unwanted but anticipated effects, which are quite common.

Pain after gallbladder removal:

• Mild to moderate pain in a surgical wound can persist for several days or few weeks.
• The gas that has remained in the abdominal cavity after laparoscopic surgery can cause severe pain below the rib cage or at the tip of the right shoulder blade for 1 or 2 days.
• Recurrent pain in the right upper abdominal quadrant that can appear months or years after gallbladder removal can be due to a motility disorder of the bile duct called sphincter of Oddi dysfunction.

Nausea or vomiting usually resolve in a couple of days after surgery ^[17].

Diarrhea usually resolves within 4-8 weeks after surgery but can become chronic and can persist for several years ^[16].

Some people can experience bloating, excessive gas (flatulence) or constipation for some time after surgery and others can develop irritable bowel syndrome ^[15].

Bile reflux, which is similar to acid reflux, can cause indigestion and heartburn persisting for several months.

Unintentional weight loss can be due to diarrhea or avoiding eating from fear of pain.

Gallbladder removal may increase the risk of fatty liver ^[1,2,3] and metabolic syndrome, which includes obesity, high LDL cholesterol and glucose levels and hypertension ^[5].

Cholecystectomy should not affect the digestion or absorption of nutrients or cause dumping syndrome ^[4].

When to see a doctor?

You can consider visiting a doctor when you experience any of the following symptoms after surgery:

• Severe abdominal pain or pain that persists for more than a month
• Bleeding or thick discharge from a surgical wound (some clear discharge is normal)
• Unexplained fever or cough
• Yellow skin and eye whites, and gray stools

• References

  1. Ruhl CE et al, 2013, Relationship of non-alcoholic fatty liver disease with cholecystectomy in the US population  PubMed
  2. Kwak M-S et al, 2015, Cholecystectomy is independently associated with nonalcoholic fatty liver disease in an Asian population  PubMed Central
  3. Nervi F et al, 2013, Cholecystectomy and NAFLD: does gallbladder removal have metabolic consequences?  PubMed
  4. Taylor TV, 1981, Postvagotomy and Cholecystectomy Syndrome PubMed Central
  5. Shen C et al, 2014, Association of Cholecystectomy with Metabolic Syndrome in a Chinese Population  PubMed Central
  6. Okoron N et al, 2008, Ursodeoxycholic acid treatment for patients with postcholecystectomy pain and bile microlithiasis  PubMed
  7. Cholecystectomy  American College of Surgeons
  8. Dewachter P et al, 2009, Anaphylaxis and Anesthesia: Controversies and New Insights  Anesthesiology
  9. Symptoms & Causes of GI Bleeding  NIDDK
  10. Duca S et al, 2003, Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations  PubMed Central
  11. Keloid  Patient.info
  12. Surgical site infections  John Hopkins Medicine
  13. Loss of sensation after surgery  Drdeuber.com
  14. Acute kidney injury (AKI)  Kidney.org
  15. Postcholecystectomy syndrome  Emedicine
  16. Gallbladder removal – laparoscopic – discharge  MedlinePlus
  17. Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES  Sages.org
  18. Macaron C et al, 2011, Recurrent abdominal pain after laparoscopic cholecystectomy  MDedge