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Re: Bile Duct Damage

Posted By HFHSM.D.-rf on May 16, 1998 at 07:36:10:

In Reply to: Bile Duct Damage posted by Julia on May 11, 1998 at 14:05:05:

Our beloved pastor suffered bile duct damage during a routine laparoscopic
cholosystectomy several months ago.  Unfortunately it took quite a while before
the damage was diagnosed and she had an extremely rough time - we thought we
had lost her twice.  The infections were widespread and apparently
resistant to treatment, and she was hospitalized for well over a month.
She is now back at work but her overall health still seems very poor. We
are concerned that she get the best medical care possible.
What long-term complications could come from this type of incident and
how can they be minimized?

Dear Julia,
Laparoscopic cholecystectomy is the surgical technique used for the removal of most diseased gall bladders.  Open procedures (the former approach with the big scar, longer hopital stay, more prolonged recovery) are used only if the laparoscopic approach can not be done.  For example, very obese patients or those with scars due to previous surgery in the area of the right upper abdomen may not be suitable for laparoscopic surgery.  The surgical technique inside the patient is the same for both surgical approaches.  In essence, the only difference is scar size and recuperation time.
The two more common and serious complications of laparoscopic cholecystectomy are bile duct leakage and bile duct narrowing.  Based your email, I think that your pastor had a bile duct leak with secondary infection.  This complication occurs when there is an opening in the bile duct so that bile (which normally passes down the duct from liver to intestine where it is involved in fat digestion) leaks into the bile abdominal cavity.  Bile is irritating to the lining and can cause severe pains.  If the bile becomes infected, then the patient can be seriously ill.  
If your pastor had multiple surgeries, it may take time until she regains all her strength.  During surgery or periods of infection, the body becomes catabolic.  This means that not enough calories are provided for the body to fight the infection.  In order to have energy necessary for essential body activities (e.g. heart function, breathing, fight infection) the body starts to use its own fat and carbohydrate stores.  When these enrgy stores are depleted, the body starts to break down muscle to obtain energy supplies.  It can take many months for an individual to return to the preinfection state of nutrition.
If the bile duct is scarred, the patient can sometimes have stasis of bile flow with jaundice and possibly infection of the bile , called cholangitis.  This possibility requires a gastrenterologist to investigate and treat.
Finally, there is the potential complication of internal scarring that can result from any intrabdominal surgery or infection.  During the healing process fibrous (scar) tissue is deposited in the abdomen.  This scar (called adhesions) may sometimes cause bowel obstruction.
It will take time for your pastor to regain strength and vigor.  One must prevent her from overdoing her activities until she has regained her strength.  Somtimes nutritional supplements e.g. Ensure is tried in an attempt to accelerate the repleneshing of energy stores in the body.  Unfortunately, there is no means for anyone to interfere with the internal healing process.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
*keywords: cholecystectomy, gall bladder surgery

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