Pain After Gallbladder Removal Surgery

Published: February 10, 2017
Last reviewed: March 6, 2017

After gallbladder removal, most individuals can expect to have mild to moderate pain from the surgical procedure lasting for few days or weeks. If the pain lasts longer or appears months later, it can be a sign of a surgery complication.

Expected Pain Due To a Surgical Procedure

The postoperative pain can arise from a surgical wound or the inflated gas.

1. Pain From a Surgical Incision or Scar

Pain in the surgical incision can persist for few days after laparoscopic and few weeks after open gallbladder surgery.

A surgical wound that is painful, reddened, swollen or draining needs to be checked by a doctor for an infection.

Normal scars should not be painful. Raised and red scars can be itchy or painful for months or years [1].

2. Pain From the Inflated Gas

The gas that has been insufflated into the abdominal cavity during a laparoscopic surgery and has remained there after the surgery can irritate the abdominal membrane (peritoneum) and cause sharp pains in the upper abdomen and lower chest. Additionally, the gas can irritate the diaphragm muscle and cause referred pain in the middle back (near the right kidney) and at the tip of the right, left or both shoulder blades [2]. Gas usually disappears in few days along with pain.

Pain Due To Surgery Side Effects or Complications

The pain that is severe or lasts for more than a month after surgery can be due to a surgery complication or side effect of the changed bile flow.

1. Internal Infection

Abdominal infection can cause fever, chills, severe abdominal pain or pus draining from the surgical wound [3].

2. Bile Leak

Bile leak can occur after an accidental injury of the common bile duct during the surgery [4,5].

3. Bile Reflux

Bile reflux can cause gastritis, peptic ulcer or esophagitis with gnawing stomach pain, burning pain behind the breastbone (heartburn) or acid burps [3,4,6,12,13,14].

4. Acute Pancreatitis

Acute pancreatitis can cause dull pain in the upper middle or left abdomen, nausea or vomiting [6].

5. Adhesions

Adhesions are bands of the connective tissue (internal scars) that often develop between the organs after abdominal surgery. They can pull the gallbladder duct, liver or intestine and cause vague right upper abdominal pains [4,7]. Adhesions can be found and removed by a laparoscopic procedure [15].

6. Bile Duct Obstruction

Bile duct obstruction can be caused by [3,4,5,8,9,17]:

Symptoms can include:

  • Pain in the right upper abdomen that appears within an hour after a meal (or at any time) remains constant for 30 minutes to several hours and is accompanied by nausea or vomiting
  • Pain that is recurrent but does not appear in regular intervals and is not relieved by burping, vomiting, passing gas, bowel movements, changing the body position or antacids
  • Pain that radiates to the middle right back or right shoulder blade
  • Fever or jaundice, which speaks for a bile duct inflammation (cholangitis)

Pain from SOD that appears in the absence of gallbladder and without an apparent reason can be similar to pain from the gallbladder, so it is often called phantom gallbladder pain, which suggests that the pain is only in your imagination. However, in most cases, the pain is real.

Treatment of Postoperative Pain

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, ketoprofen or rofecoxib, should help in mild to moderate pain [18]. For stronger pain, a doctor can prescribe narcotics, such as morphine [18]. Doctors avoid prescribing morphine because of several possible side effects [18].

What to do if you still have pain months after gallbladder removal?

Pain that persists for months or years after the surgery is not normal, especially if it is associated with nausea, vomiting, fever or jaundice. In order to find the cause, you can discuss with your doctor about investigations, such as:

  • Classical abdominal ultrasound
  • Endoscopic ultrasound
  • The magnetic resonance imaging called MRCP
  • An endoscopic investigation called ERCP
  • Laparoscopic investigation of the abdomen

Other common causes of right upper abdominal pain include muscle strain, trapped wind, peptic ulcer, pleurisy and congestive heart failure with an enlarged liver.

  • References

      1. Wilhelmi BJ, Widened and Hypertrophic Scar Healing, Presentation  Emedicine
      2. Abdominal Pain from Laparoscopic Surgery  AbdoMend
      3. Laparoscopic Gallbladder Removal (Cholecystectomy) Patient Information from SAGES
      4. Girometti R et al, 2010, Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography  PubMed Central
      5. Duca S et al, 2003, Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations  PubMed Central
      6. Jensen SW, Postcholecystectomy syndrome, overview  Emedicine
      7. Hyvärinen H et al, Intestinal adhesions: an overlooked cause of the postcholecystectomy syndrome  PubMed
      8. Okoro N et al, 2008, Ursodeoxycholic acid treatment for patients with postcholecystectomy pain and bile microlithiasis  PubMed
      9. Okoron N et al, 2008, Ursodeoxycholic acid treatment for patients with postcholecystectomy pain and bile microlithiasis  PubMed
      10. Otto S Lin, The Association between Cholecystectomy and Gastroesophageal Reflux Symptoms: A Prospective Controlled Study  PubMed Central
      11. Gupta R et al, 2014, Evaluation of gastroesophageal reflux after laparoscopic cholecystectomy using combined impedance-pH monitoring  PubMed
      12. Ahmad BN et al, 2003, Duodenogastric reflux, an important cause of post-cholecystectomy symptoms  MedIND
      13. Kalima T et al, 1981, Bile reflux after cholecystectomy  PubMed
      14. Chen H et al, 2010, Rabeprazole combined with hydrotalcite is effective for patients with bile reflux gastritis after cholecystectomy  PubMed Central
      15. Villanueva MSS, Laparoscopic Adhesiolysis,  Emedicine
      16. Brugge WR, Bile Duct Strictures Treatment & Management  Emedicine
      17. Rome II diagnostic criteria for functional gastrointestinal disorders
      18. Bisgaard T, 2006, Analgesic Treatment after Laparoscopic Cholecystectomy: A Critical Assessment of the Evidence  Anesthesiology

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