Gallbladder surgery problems more common in older patients

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Complications from minimally invasive gallbladder surgery are rare, but they can be more common in older patients like Rep. John Murtha, two leading surgeons say.

The 77-year-old Johnstown Democrat is reported in stable condition in the intensive care unit at Virginia Hospital Center, following complications from gallbladder removal surgery Jan. 28 at the National Naval Medical Center in Bethesda, Md.

The typical risk of bleeding or infection from laparoscopic gallbladder surgery is about 1 percent, says Rochester surgeon Raymond Lanzafame, but it can be higher in older patients, particularly if they have had previous abdominal surgery that leaves scarring, says surgeon Michael Kavic of Youngstown, Ohio.

Dr. Lanzafame is past president of the Society of Laparoendoscopic Surgeons, and Dr. Kavic is editor in chief of the society's journal.

Sources close to Mr. Murtha say his intestine was inadvertently nicked during the gallbladder removal but did not indicate whether it was the small or large intestine.

The section of the small intestine that leaves the stomach, called the duodenum, sits right below the gallbladder. The large intestine is normally farther away but can be closer if scar tissue from previous surgery has shifted its position, Dr. Kavic says.

A tear in either intestine can cause infection that's serious enough to land someone in the ICU, both doctors say.

In a laparoscopic gallbladder removal, surgeons typically make four small incisions in the abdomen. A fiber optic camera and light are inserted in one opening, so surgeons can watch what they're doing on a TV monitor.

An assistant usually uses two of the incisions to insert instruments that retract organs and stretch the gallbladder out, and the surgeon can use the other opening to snip the cystic duct and pull the gallbladder out.

The gallbladder is essentially a storage depot for digestive bile liquid made by the liver. It empties its contents into the small intestine to help with digestion, but in an estimated 1 million people each year, cholesterol in the bile settles out as hard gallstones that can block the bile duct and cause intense pain.

That's often when surgeons decide to remove the gallbladder and just let the bile drain directly from the liver into the small intestine.

Of the more than 750,000 gallbladder removals done each year in the United States, nearly three-quarters are laparoscopic, Dr. Lanzafame says.

The main reason? Laparoscopic patients can go back to daily activities in four to 10 days, compared with being out about six weeks with a full incision.

Mark Roth: or 412-263-1130.


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