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Laparoscopic gallbladder surgery
Risks of laparoscopic gallbladder surgery
Conversion to an open procedure
It is necessary for surgeons to make a larger incision to finish gallbladder surgery safely up to 5% of the time. This may be necessary because of scarring or adhesions from prior surgeries, marked swelling or inflammation of the gallbladder, or the inability for important landmarks to be adequately visualized by the surgeon. The surgeon will use his or her best judgment to do what is safest in any particular situation.
Persistent pain following surgery
Pain is the most common symptom leading to gallbladder surgery. It is not always possible to confirm that the gallbladder is responsible for all symptoms prior to surgery. Persistent pain may continue in about 3 to 5 % of people who undergo gallbladder surgery. This is because something other than the gallbladder was responsible for the pain or other symptoms. In these cases, further testing may be necessary after gallbladder surgery.
Infection
Infection at the small incision sites can be seen in about 1% of people undergoing gallbladder surgery. This can usually be treated without additional surgery. More serious infections deeper in the abdomen are less common. Many of these can be treated with a minimally invasive drain placement with x-ray imaging. Occasionally, a deep infection may require additional surgical or minimally invasive procedures.
Bile leak
Leakage of bile can occur in about 1% of gallbladder surgeries. Bile can leak from the cystic duct which was divided for gallbladder removal, or from the surface of the liver where the gallbladder was previously attached. If a leak is present, it usually causes worsening upper abdominal pain 2 to 3 days after surgery and may be associated with nausea or a fever. Once the leak is recognized, an endoscopic procedure to place a stent within the common bile duct will help minimize further leakage. This is typically combined with a minimally invasive procedure to drain the leaked bile from within the abdomen.
Incisional hernia
Hernias develop in less than 1% of people having gallbladder surgery. Hernias occur when the muscle layer at an incision fails to heal, and are recognizable as a swelling or bulge beneath one of the scars developing weeks to months after surgery. A firm knot or bulge beneath the incision within the first few days after surgery is normal, and is rarely a hernia. Repair of this type of hernia requires a surgical procedure, usually as an outpatient.
Bleeding
Bleeding from the skin incisions is typically minimal, rarely dangerous and often will stop with application of gentle pressure. Bruising may commonly be seen, especially in individuals on aspirin or blood thinners. More serious internal bleeding associated with injury to larger blood vessels is known to occur in less than 0.5% of surgeries. This is typically recognized at the time of surgery and may require conversion to an open procedure.
Injury to other structures
The gallbladder is attached to the undersurface of the liver, and has to be dissected away from the liver to be successfully removed. The gallbladder is also close to other structures such as the stomach, small bowel, colon and diaphragm. Such uncommon injuries, less than 1%, might be seen with severe gallbladder inflammation or severe scarring from prior upper abdominal surgeries. Conversion to an open surgery may often be required to repair these injuries.
Common bile duct injury
The common bile duct is a vital structure allowing normal bile flow from the liver to the small bowel. Injury to the common bile duct can occur in about 1 in 250 surgeries. A clip might be placed in a position which blocks the bile duct and prevents normal bile flow, or the bile duct might be accidentally cut. Either injury typically requires additional surgical and endoscopic procedures for repair. Occasionally, multiple surgeries may be necessary. Most such injuries are recognized at the time of surgery. Persons with a bile duct injury are typically referred to a center with advanced expertise in managing this type of injury.
Diarrhea
Loose bowel movements are fairly common immediately after gallbladder surgery. Improvement of symptoms can be expected within a few days. Avoidance of greasy or fatty foods will typically minimize loose bowel movements. Severe persistent diarrhea is uncommon and occurs in less than 1% of individuals. Oral medications may be helpful.
Bowel obstruction
Any surgical procedure, including gallbladder removal, can result in formation of scar or adhesions. Such scarring in the abdomen is associated with a risk of bowel obstruction. Bowel obstruction can also develop if a small loop of bowel gets trapped in a hernia when the muscle layer of an incision fails to heal. Bowel obstruction is seen very infrequently following laparoscopic gallbladder surgeries, but up to 6% in open gallbladder surgeries.
Death
Death is uncommonly related to gallbladder surgery. Healthy individuals have a less than 1 in 1,000 chance of death. Risk of death increase with other medical problems such as heart disease, COPD, diabetes, obesity and other medical conditions. Age also increases the risk of death associated with gallbladder surgery, but a reasonably healthy individual 70 years of age has a risk of death of only about 2%.