Cholecystectomy – Open & Exploration of the Common Bile Duct

What is a cholecystectomy – open and exploration of the common bile duct?

This procedure entails the removal of the gall bladder through a cut at least 10 cm (4 inches) long, across the right side of the abdomen, just below the rib cage. The surgeon will also examine the tube, which carries bile from the liver to the bowel and remove any stones. A drainage tube (a T-Tube) will be inserted into the tube and brought out through the abdomen to drain bile into a drainage bag on the outside of the body. The tube will be removed in 1 – 3 weeks.

During surgery an examination of the bile duct is required to look for gallstones. To do this a Contrast medium is injected and X-rays are taken of the bile duct.

Anaesthetic

This procedure will require an anaesthetic.

What are the risks of this specific procedure?
There are risks and complications with this procedure.
They include but are not limited to the following:

General risks:

• Infection can occur, requiring antibiotics and further treatment.
• Bleeding could occur and may require a return to the operating room. Bleeding is more common if you have been taking blood thinning drugs such as Warfarin, Asprin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).
• Small areas of the lung can collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
• Increased risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis.
• Heart attack or stroke could occur due to the strain on the heart.
• Blood clot in the leg (DVT) causing pain and swelling. In rare cases, part of the clot may break off and go to the lungs.
• Death as a result of this procedure is possible

Specific risks:

• Damage to nearby blood vessels causing bleeding which could require an emergency blood transfusion and further surgery.
• Gallstones may spill from the gall bladder and be lost in the abdominal cavity. These may form abscesses, which may need drainage.
• Some stones may be left behind in the bile duct and may need further treatment.
• The T-tube may come out of position. Further surgery may be required to re-insert the T-Tube.
• Metal clips may be put on blood vessels or tubes and some of the clips or ties may come off and cause a bile leak or bleeding which may become infected. The metal clips will always stay in the abdomen.
• Damage to the bile tubes near the liver and gall bladder which can cause short and long term problems with leakage and/or blockage.
• Difficulty passing urine after the operation and may need a catheter passed into the bladder to remove the urine. This is usually temporary.
• Occasionally after the T-tube is removed, 2 or 3 weeks after the operation, bile may leak out of the bile duct to the skin or into the abdominal cavity.
• Infections in the wound causing redness, pain and possible discharge or abscess. This may need antibiotics.
• Possible bleeding into the wound with swelling and bruising and possible blood stained discharge.
• The wound may not heal normally. The wound can thicken and turn red. The scar may be painful.
• A weakness can occur in the wound with the development of a hernia (rupture). Further surgery may be needed to correct this.
• Adhesions (bands of scar tissue) may form and cause bowel obstruction. This can be a short term or a long term complication and may need further surgery.
• Symptoms experienced before surgery may persist after the surgery.
• An allergic reaction to the injected contrast is rare.