Can Gallstones still be present after a cholecystectomy?


Why is there pain even after the gall bladder removal?

Mrs. Agrawal, a 56 years old lady visited Gastroenterology clinic with right side abdominal pain for 5 days. She has a history of a laparoscopic cholecystectomy performed 6 months back, the gastroenterologist is bit concerned now. Can she have a recurrence of gall stones? Is it possible after the removal of gall?

Why does the patient experience gall stone pain even after removal of gall bladder?

The gold standard treatment for symptomatic gall stones is laparoscopic cholecystectomy. But pain may be present in few patients even after gall bladder removal surgery. Rarely pain may occur due to potential irritation by gall stones which were lost or spilled during the surgical intervention.

How is this Possible?

  • Fatty Liver:

Though it is necessary to remove diseased gall bladder to avoid later complications but some patient may experience pain if liver is not healthy- there is fatty liver.
So a good diet including high fiber, high protein and good fat is necessary.

  • Choledocholithiasis (gallstones in the bile duct)

According to Medical Clinic of North America, about 15% of patients with gallstones have gallstones in the bile duct as well. So even after the removal of gallbladder, they will still have sporadic symptoms like abdominal pain, jaundice, fever, loss of appetite etc. which should be intervened as soon as possible with proper treatments.

  • Gallstone spillage

Spilled stones during an open cholecystectomy can easily be evacuated directly by a copious irrigation or mopping with laparotomy sponges. But on laparoscopy, it is quite difficult due to minimal invasiveness where the stones would either be invisible or get lost in other organs.

According to latest research studies, the incidence of spilled gallstones on laparoscopic cholecystectomy marks for 6-40% whereas 13-32% of such cases account for lost stones, which were not able to be removed.

Such stones which are left within the peritoneal cavity can give rise to a significant morbidity which is why proper medical advice is recommended for clinically suspected patients.

Spilling of gallstones can take place as a result of gallbladder perforation due to acutely inflamed organs with friable tissues which are at a risk of tearing, aggressive manipulation with instruments during the surgery and slipping of the cystic duct clip or tearing of gallbladder following the retrieval from the port site.

Patients can have bowel obstruction, sinus infection or fistula, depending on the site of lodging of stone and severity of obstruction or irritation of surrounding organs.

But these risky situations can be easily avoided by expert surgical knowledge and years of experience in the field. Surgical Gastroenterologists in Mumbai, India are highly popular for performing successful cholecystectomy with a low incidence of complications.

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Saturday, 20 October 2018

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