What Is a Postoperative Bile Leak?

Cholecystectomy is the most common operation in biliary surgery. Since Lengenbuch underwent the first cholecystectomy in 1882, it has a history of more than 100 years. In most cases, the operation is relatively standard, and the long-term results after the operation are also satisfactory. It is suitable for all kinds of acute and chronic cholecystitis, symptomatic gallstones, and gallbladder elevated lesions.

Basic Information

Chinese name

Cholecystectomy

Foreign name

cholecystectomy

Visiting department

General surgery

Preparation before cholecystectomy anesthesia

Anesthesia mode

Epidural or general anesthesia.

2. Preoperative preparation

(1) Ask for detailed medical history and systematic physical examination.

(2) Laboratory examination and evaluation of heart, lung, liver, kidney and other important organ functions.

(3) Review various imaging diagnostic data to clarify the location, nature, and extent of the lesion, and provide a basis for the design of the surgical plan.

(4) Application of preventive antibiotics.

(5) Symptomatic treatment of accompanying diseases.

Indications for cholecystectomy

Acute cholecystitis; symptomatic chronic cholecystitis and gallstones; gallbladder polyps or gallbladder cancer; internal and external gallbladder fistulas; traumatic rupture of the gallbladder.

Cholecystectomy contraindications

The etiology of obstructive jaundice is unclear; patients with organ insufficiency can not tolerate surgery; chronic upper right abdominal pain, but B-mode ultrasound and cholecystography have not found gallbladder abnormalities.

Cholecystectomy surgery steps

The general steps of the operation: right oblique incision or right rectus abdominis incision. Exploration. There are two methods to remove the gallbladder, namely the antegrade resection, which starts from the gallbladder duct, and the gallbladder is stripped from the bottom to the top; After the gallbladder is removed from the gallbladder bed, the gallbladder canal is processed. Close the abdominal cavity.

Postoperative cholecystectomy complications

Recent complications are mainly postoperative bleeding, bile leakage, biliary peritonitis, subhepatic effusion or subsacral abscess, postoperative jaundice, postoperative pancreatitis, common bile duct stones, and gastrointestinal fistula. Long-term complications include bile duct stenosis, recurrent bile duct stones, biliary tract bleeding, postoperative cholecystectomy syndrome, excess cystic duct residual syndrome, and increased incidence of colon cancer.

Nursing after cholecystectomy

1. Postoperative supine, without shock, change to semi-seated position the next day.

2. Abdominal bloating and vomiting are not serious. The day after the operation can begin to enter a non-bloating liquid diet, and gradually increase the amount of food. Patients with severe bloating and intestinal paralysis should continue to fast for 1 to 2 days after operation, and perform gastrointestinal decompression if necessary. Intravenous fluids should be given during fasting.

3. Continue to use antibiotics.

4. Those with jaundice continue to use liver-protective drugs.

5. Drainage is usually removed 2 to 3 days after surgery.

Cholecystectomy considerations

1. Choose digestible foods.

2. Maintain an optimistic attitude towards life and avoid negative emotions such as anxiety and depression. Within two or three months after the operation, activities such as walking can be performed to promote the recovery of the body.

3. Regularly review and take medicines as prescribed by your doctor and return to the hospital regularly.

Diet after cholecystectomy

In the early postoperative period of the gallbladder, a low-fat, low-cholesterol, adequate diet with high-quality protein, vitamins, and trace elements should be used for at least 2 weeks. Postoperative fat intake does not exceed 30 g per day, cholesterol intake does not exceed 300 mg per day, and daily energy intake is preferably 20 to 25 kcal / kg. The dietary fiber should choose soluble fiber from pectin, algin, and soybean gum, and ensure adequate drinking water. Diet should use soft-slag soft rice prepared by stewing, steaming, etc. It is also important to avoid frying and frying.