Laparoscopic Cholecystectomy or ‘Lap Chole’ is a common procedure and seems like the growing use of weight loss drugs like Ozempic (Semaglutide) or Zepbound (Tirzepatide) is going to keep gallbladder surgeons busy! Persistent Pain is often seen following Laparoscopic Gall-bladder removal surgery – A clinician should be able to figured out a cause or if a complication has occurred. This begins with knowing the common causes of such post-op pain. A patient was recently awarded 10 Million US Dollars after a botched Lap Chole where the surgeon clipped the Common Bile Duct (CBD) instead of the cystic duct causing significant injury and complications to the patient!
Remember the complications of Lap Chole or causes of persistent post-operative pain with this self-suggestive “LAP-C” Mnemonic:
L – Leak (Bile leak from cystic duct stump OR other damaged biliary channels)
A – Abscess, Air trapping (CO2 is used to inflate the surgical area during the procedure to see things better, retained CO2 gas can cause transient pain after surgery), ACNES
P – Perforation (Abdomen, Biliary duct, Liver, etc), Pancreatitis
C – CBD Stones/Strictures , Cutting wrong tubes !
- Bile leak – Can be diagnosed with a HIDA scan
- Abscess – a late complication often accompanied by fever/leukocytosis – a CT scan can help
- Air Trapping or Iatrogenic Pneumoperitoneum – should resolve on own, these days a valve is used to release the extra gas prior to closing sutures
- ACNES: rare, persistent pain for months after, Carnett’s sign can help
- Perforation – A CT scan can help
- Pancreatitis – A Gallstone that might have passed right around the time of surgery won’t show up on the intra-op cholangiogram but could result in Pancreatitis with Lipase & LFT elevations a little later
- CBD stones that are retained can be seen with an MRCP!
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