Most individuals can expect to have mild to moderate pain for several days to weeks after gallbladder removal surgery. 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 pain after surgery can arise from a surgical wound or the gas insufflated into the abdominal cavity during the procedure.
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 .
2. Pain From the Insufflated Gas
The gas that has been insufflated into the abdominal cavity during a laparoscopic surgery can irritate the abdominal membrane (peritoneum) and cause sharp pain in the abdomen. Additionally, the gas can irritate the diaphragm muscle between the abdominal and chest cavity and cause pain in the lower chest and middle back and referred pain at the tip of the right, left or both shoulder blades . The gas and pain usually disappear in few days.
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 .
2. Bile Leakage
Bile leakage can occur after an accidental injury of the 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].
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 .
5. Bile Duct Obstruction
Bile duct obstruction can be caused by [3,4,5,8,9,17]:
- Gallstones or bile crystals (microlithiasis)
Symptoms of bile duct obstruction 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, radiates to the middle right back or right shoulder blade and is accompanied by nausea or vomiting
- Fever or jaundice, which speaks for a bile duct inflammation (cholangitis)
6. Acute Pancreatitis
Acute pancreatitis, which rarely develops after gallbladder removal, can cause dull pain in the upper middle or left abdomen, nausea, vomiting and fever .
Treatment of Postoperative Pain
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, ketoprofen or rofecoxib, should help in mild to moderate pain . For stronger pain, a doctor can prescribe narcotics, such as morphine . Doctors tend to avoid prescribing morphine if they suspect that the pain may be due to sphincter of Oddi dysfunction because it can worsen the pain .
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 or endoscopic ultrasound
- A type of magnetic resonance imaging called MRCP
- An endoscopic retrograde cholangiopancreatography (ERCP)
- Laparoscopic investigation of the abdomen
Phantom Gallbladder Pain
If nothing is found, a motility disorder of the bile duct called sphincter of Oddi dysfunction (SOD) should be suspected. The pain from SOD, which often develops after gallbladder removal, can be similar to pain from the gallbladder, so it is often called phantom gallbladder pain.
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