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Updated -- Sludge Report. Gall bladder surgery seven years after gastric bypass.

Gallbladder-plush_med
An increased risk of gallstone formation has been linked to obesity and to episodes of rapid and significant weight loss.  Gee, thank you Weight Loss Surgery!  <wink wink>  

I am lucky, as my wee gall bladder was removed during my gastric bypass surgery as it was found full of sludge during the procedure, and saved me some future grief.  

Mr. MM had gastric bypass surgery five weeks after I did, and he got to keep his gall bladder.  (Aww, thanks!)

He's been having attacks of abdominal pain for months years, which have always been dubbed "gas."  (Because, he is always full of it anyway.)  Much of the time, he's found doubled up on Gas-X and in the fetal position waiting for death. I know my fellow gastric bypassed post ops UNDERSTAND this pain, it's RANDOM, UNEXPLAINABLE, and INTERMITTENT.  Many of us deal with undiagnose-able belly pains, and mostly, it's gas.  Many of us have spent time in the ER getting no diagnosis for issues like this, so it's hard to decipher, WHAT is CAUSING this pain today?  (I have one today, I can't decide if it's a reaction to the cold I have, or if I am constipated or if I just want to stop eating food forever.)

But, this last episode sent Mr. MM to the hospital, as I was thinking there might be something kinking his intestine, because he also has a hernia.  

Dr. Hanafy a Bariatric Surgeon -

"Formation of gallstones or sludge in the gallbladder is known to increase with obesity and with rapid weight loss. According to one report, at 6 months, gallstones had developed in 36% and gallbladder sludge in additional 13% of patients

But another question is: What percentage of patients will actually develop symptoms or problems from gallstones or sludge after bariatric surgery? Well, reports quote anywhere from 3% to 30%."

This is a GREAT video with information, ignore the fact that it's leading to a commercial for cleansin' --

So, Mr. MM has gall bladder removal surgery tomorrow.  We hope that this will stop his more intense attacks of pain.  Yes, he wishes that they just took his during the gastric bypass, because this sucks.  During the surgery, the surgeon said that he'd take a peek and see if he can see the hernia as well, and if it's visible, they may fix it.  Two for the price of one. "Confetti."

Update - it's done.  Mr. MM had a GB full of big stones.  It's OUT.  While the surgeon was poking around in there, he found an area of adhesions close to where Mr. had been pointing to "hernia pain."  He fixed it, and explained that this should relieve the issues he's been having.  

After a very long day, we are home, and he's realized once again that narcotic pain medication doesn't "work the same" in a RNY gut.  It's like alcohol, in that it's IN, ON and OUT.  He's asked for another dose, and he's realized, that "it's still three hours?"  Next dose will be a full one, to get to sleep.

He thinks he's going to work by mid-week.  The boy is tapped.  

I will update more if anything occurs.

SAGES - Information about the surgery

PATIENT INFORMATION FROM YOUR SURGEON & SAGES

Laparoscopic Gall Bladder Removal

Gallbladder removal is one of the most commonly performed surgical procedures in the United States. Today, gallbladder surgery is performed laparoscopically. The medical name for this procedure is Laparoscopic Cholecystectomy.

WHAT IS THE GALLBLADDER?

  • The gallbladder is a pear-shaped organ that rests beneath the right side of the liver.
  • Its main purpose is to collect and concentrate a digestive liquid (bile) produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through narrow tubular channels (bile ducts) into the small intestine.
  • Removal of the gallbladder is not associated with any impairment of digestion in most people.

WHAT CAUSES GALLBLADDER PROBLEMS?

  • Gallbladder problems are usually caused by the presence of gallstones: small hard masses consisting primarily of cholesterol and bile salts that form in the gallbladder or in the bile duct.
  • It is uncertain why some people form gallstones.
  • There is no known means to prevent gallstones.
  • These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting, indigestion and, occasionally, fever.
  • If the gallstone blocks the common bile duct, jaundice (a yellowing of the skin) can occur.

HOW ARE THESE PROBLEMS FOUND AND TREATED?

Ultrasound is most commonly used to find gallstones.

  • In a few more complex cases, other X-ray tests may be used to evaluate gallbladder disease.
  • Gallstones do not go away on their own. Some can be temporarily managed with drugs or by making dietary adjustments, such as reducing fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue unless the gallbladder is removed.
  • Surgical removal of the gallbladder is the time honored and safest treatment of gallbladder disease.

WHAT ARE THE ADVANTAGES OF PERFORMING THE PROCEDURE LAPAROSCOPICALLY?

  • Rather than a five to seven inch incision, the operation requires only four small openings in the abdomen.
  • Patients usually have minimal post-operative pain.
  • Patients usually experience faster recovery than open gallbladder surgery patients.
  • Most patients go home within one day and enjoy a quicker return to normal activities.

ARE YOU A CANDIDATE FOR LAPAROSCOPIC GALLBLADDER REMOVAL?

Although there are many advantages to laparoscopy, the procedure may not be appropriate for some patients who have had previous upper abdominal surgery or who have some pre-existing medical conditions. A thorough medical evaluation by your personal physician, in consultation with a surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal is an appropriate procedure for you.

WHAT PREPARATION IS REQUIRED?

The following includes typical events that may occur prior to laparoscopic surgery; however, since each patient and surgeon is unique, what will actually occur may be different:

  • Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
  • After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
  • Your surgeon may request that you completely empty your colon and cleanse your intestines prior to surgery. You may be requested to drink clear liquids, only, for one or several days prior to surgery.
  • It is recommended that you shower the night before or morning of the operation.
  • After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
  • Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
  • Quit smoking and arrange for any help you may need at home.

HOW IS LAPAROSCOPIC GALLBLADDER REMOVAL PERFORMED?

  • Under general anesthesia, so the patient is asleep throughout the procedure.
  • Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen in the area of the belly-button.
  • A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs on a television screen.
  • Other cannulas are inserted which allow your surgeon to delicately separate the gallbladder from its attachments and then remove it through one of the openings.
  • Many surgeons perform an X-ray, called a cholangiogram, to identify stones, which may be located in the bile channels, or to insure that structures have been identified.
  • If the surgeon finds one or more stones in the common bile duct, (s)he may remove them with a special scope, may choose to have them removed later through a second minimally invasive procedure, or may convert to an open operation in order to remove all the stones during the operation.
  • After the surgeon removes the gallbladder, the small incisions are closed with a stitch or two or with surgical tape.

WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED OR COMPLETED BY THE LAPAROSCOPIC METHOD?

In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the "open" procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.

WHAT SHOULD I EXPECT AFTER GALLBLADDER SURGERY?

  • Gallbladder removal is a major abdominal operation and a certain amount of postoperative pain occurs. Nausea and vomiting are not uncommon.
  • Once liquids or a diet is tolerated, patients leave the hospital the same day or day following the laparoscopic gallbladder surgery.
  • Activity is dependent on how the patient feels. Walking is encouraged. Patients can remove the dressings and shower the day after the operation.
  • Patients will probably be able to return to normal activities within a week's time, including driving, walking up stairs, light lifting and working.
  • In general, recovery should be progressive, once the patient is at home.
  • The onset of fever, yellow skin or eyes, worsening abdominal pain, distention, persistent nausea or vomiting, or drainage from the incision are indications that a complication may have occurred. Your surgeon should be contacted in these instances.
  • Most patients who have a laparoscopic gallbladder removal go home from the hospital the day after surgery. Some may even go home the same day the operation is performed.
  • Most patients can return to work within seven days following the laparoscopic procedure depending on the nature of your job. Patients with administrative or desk jobs usually return in a few days while those involved in manual labor or heavy lifting may require a bit more time. Patients undergoing the open procedure usually resume normal activities in four to six weeks.
  • Make an appointment with your surgeon within 2 weeks following your operation.

WHAT COMPLICATIONS CAN OCCUR?

While there are risks associated with any kind of operation, the vast majority of laparoscopic gallbladder patients experiences few or no complications and quickly return to normal activities. It is important to remember that before undergoing any type of surgery--whether laparoscopic or open you should ask your surgeon about his/her training and experience.

Complications of laparoscopic cholecystectomy are infrequent, but include bleeding, infection, pneumonia, blood clots, or heart problems. Unintended injury to adjacent structures such as the common bile duct or small bowel may occur and may require another surgical procedure to repair it. Bile leakage into the abdomen from the tubular channels leading from the liver to the intestine may rarely occur.

Numerous medical studies show that the complication rate for laparoscopic gallbladder surgery is comparable to the complication rate for open gallbladder surgery when performed by a properly trained surgeon.

WHEN TO CALL YOUR DOCTOR

Be sure to call your physician or surgeon if you develop any of the following:

  • Persistent fever over 101 degrees F (39 C)
  • Bleeding
  • Increasing abdominal swelling
  • Pain that is not relieved by your medications
  • Persistent nausea or vomiting
  • Chills
  • Persistent cough or shortness of breath
  • Purulent drainage (pus) from any incision
  • Redness surrounding any of your incisions that is worsening or getting bigger
  • You are unable to eat or drink liquids


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