erative infection. The surgeon often administers
preoperative and postoperative doses of ANTIBIOTIC
MEDICATIONSas a prophylactic measure for infec-
tion. Factors that can complicate or slow recovery
include DIABETES, OBESITY, and bleeding or clotting
disorders. For reasons doctors do not fully under-
stand, 15 to 20 percent of people who undergo
cholecystectomy (either laparoscopic or open)
continue to experience symptoms similar to those
of gallbladder disease even after surgery, called
postcholecystectomy syndrome. Occasionally gall-
stones can escape from the gallbladder during sur-
gery and become trapped in the common bile duct
or cystic bile duct, requiring a follow-up proce-
dure, typically ENDOSCOPIC RETROGRADE CHOLAN-
GIOPANCREATOGRAPHY (ERCP), to remove them.
Rarely, gallstones can form in the bile ducts
months to years after cholecystectomy.
Postoperative infection is a significant risk with
open cholecystectomy and in people who have
diabetes or obesity, as these conditions can impair
HEALING. Warning signs of infection include
- increased PAINat the incision site
- pain elsewhere in the abdomen
- drainage from the incision site
- FEVER(temperature above 101ºF)
- NAUSEAand VOMITING
Prompt antibiotic therapy successfully treats
most postoperative infections. Persistent infection
or delayed treatment may result in an ABSCESSthat
requires additional surgery to open and drain the
infection.
BENEFITS AND RISKS OF CHOLECYSTECTOMYBenefits Risks
ends symptoms intraoperative or
restores normal digestion postoperative bleeding
averts symptom-related ANESTHESIAreaction
complications postoperative PAIN
postoperative INFECTION
inadvertent damage to LIVER
and other structures
scarring and adhesions
postcholecystectomy
syndrome
Outlook and Lifestyle Modifications
Cholecystectomy eliminates symptoms in about 80
percent of people who have gallbladder disease.
Most people return to the same lifestyle habits as
before surgery, including eating. The liver contin-
ues to manufacture bile, which flows directly into
the small intestine. The body adapts to the weaker
concentration of this bile within a few weeks of the
cholecystectomy, and digestion returns to normal.
Some people find that high-fat meals generate mild
to moderate gastrointestinal distress or mimic gall-
bladder disease symptoms for several months after
surgery. People who undergo open cholecystec-
tomy may be unable to participate in strenuous
physical activities for up to six months while the
abdominal muscles regain STRENGTH.
See also HEPATIC ABSCESS; JAUNDICE; SURGERY BENE-
FIT AND RISK ASSESSMENT.cholecystitis See GALLBLADDER DISEASE.cholelithiasis See GALLBLADDER DISEASE.cholestasis Inadequate or lack of BILE flow
resulting from either obstruction of theBILE DUCTS
or dysfunctions of the LIVER. Common symptoms
of cholestasis include- JAUNDICE(yellow discoloration of the SKIN)
- PRURITUS(generalized itching)
- easy bruising
- pale stools and dark URINE
- xanthomas (fatty deposits in the dermis layer of
the skin)
CONDITIONS THAT CAN CAUSE CHOLESTASIS
BILIARY ATRESIA gallstones
HEPATITIS HEPATOXINS
LIVER DISEASE OF ALCOHOLISM medication SIDE EFFECTS
obstructedBILE DUCTS PANCREATIC CANCER
PANCREATITIS PRIMARY BILIARY CIRRHOSISThe diagnostic path includes blood tests to con-
firm the cholestasis, typically the levels of BILIRUBIN
and the enzyme alkaline phosphatase, both of
which become elevated with cholestasis. Other
diagnostic procedures may include ULTRASOUND,cholestasis 23