Tuesday, June 9, 2009

Bile Duct Injury Complications of Laparoscopic Cholecystectomy



Since its introduction in the late 1980s, laparoscopic cholecystectomy has become the treatment of choice for symptomatic gallstone disease. Today more than 75% of cholecystectomies are performed laparoscopically. By choosing laparoscopic cholecystectomy vs. open cholecystectomy , the patient can achieve a better cosmetic result with less scarring, a faster recovery with return to normal activity and a shorter hospital stay. Regretfully, there are a variety of laparoscopic cholecystectomy complications. These complications include bowel perforation, infection, hemorrhage and burns, but for the purposes of this article we will concentrate on the most serious complication: bile duct injury. The incidence of bile duct injury during laparoscopic cholecystectomy has decreased but remains as high as 1.4%. During this discussion I hope to offer an overview of the pertinent anatomy, a description of the surgical procedure and a discussion of the complications and most common surgical repairs.


The gallbladder is a pear-shaped sac that is attached to the bottom surface of the liver. It stores bile between meals, concentrates the bile by reabsorbing water and releases the bile when needed to help the body digest fatty foods. Bile is carried from the liver and gallbladder to the small intestine via the bile ducts. The largest of these ducts is the common bile duct. This duct is formed by a joining of the common hepatic duct that leads down from the liver and the cystic duct that leads from the gallbladder. The common bile duct is vitally important since it is the only pathway through which bile can travel from the liver to the intestines.



A laparoscopic cholecystectomy is the surgical removal of the gallbladder that does not require a large open abdominal incision. Several small openings are created with sharp instruments called trocars. A laparoscope and other surgical instruments are inserted through these openings and controlled via a view through the scope. The scope is often assisted by a small video camera mounted in the scope. The procedure is relatively straightforward. The cystic duct and cystic artery leading to the gallbladder must be clipped and divided, the gallbladder dissected free from the liver and then the gallbladder can be removed. But it is vitally important that the surgeon properly identify the cystic duct prior to the clipping or division of the bile duct. Mistakes in the identification of the bile ducts can often lead to injury to the common hepatic duct or common bile duct. These injuries include excision, division, narrowing and occlusion of these structures.

Narrowing or occlusion of the bile ducts can lead to a back up of bile leading to damage to the liver. Excision or division of the bile ducts results in leakage of bile into the abdominal cavity leading to widespread infection and peritonitis. This can damage multiple organs and even result in fatal sepsis. Complications are generally minimal if the errors are realized during surgery or recognized promptly. The most serious cases generally involve delays or failure to diagnose the complications. Treatment of intra-operative bile duct injuries often involves a complex open procedure called a hepaticojejunostomy (or Roux-en-Y) in which a loop of small intestine is divided and pulled up to the liver where the small bowel is connected directly with the damaged bile duct. This procedure is much more involved than the original laparoscopic cholecystectomy procedure and results in all of the post-operative negatives that the laparoscopic technique had attempted to avoid. These negatives include pain, scarring, extended hospital stay and prolonged recovery. In worse cases, continued complications can result in multiple surgeries, progressive deterioration and even death. Even in the best cases, patients experiencing iatrogenic bile duct injuries will experience a decreased quality of life moving forward.

24 comments:

  1. Excellent article! How did you know that we have a case like this?

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  2. It's certainly a popular topic. Give me a call if you need any assistance with your case. (800) 338-5954.

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    1. In 2008 my main bile duct was cut off in gal bladder surgery i stay sick at stomach sit home for 5 daus calling dr and told gas pain hospitalized for mths home health a year gave self iv dilaudid in pick line myself phenergan got intestinal virus in bloodstream almost died year aftet surgery now i have liver disease no ins. From throwing up teeth r all going to have to be pulled in pain all time cant afford doc or dentist. Cant even get med care is. Anything i can do

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  3. This nightmare of the worst case scenerio happened to me. Still have problems, with no relief and mounting bills. Dr. blew it of as normal, to have the bile duct blow off 7 days later, and to 3 1/2 months later be back in the hospital following his supposed fix, with further leakage, and liver damage. Why can't Dr's slow down and take their time to properly identify things. Day of my operation I was at the hospital at 6:30 am, taken in to surgery after prep at around 9 am. With a 40 minute drive to get home (hubby drove) I was in my own home in my own bed by 11:30 am not fully awake or coherent yet. It took 4 more surgeries to fix what was done wrong the first time. I'm in a holding pattern (scared shitless) to have the next surgery to repair things. I've found the repository of where the Dr's who graduate at the bottom of their class live.

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  4. I am a 48 year old female and on Oct 19th 2009 had Laparscopic Cholceystectomy Gall Bladder removel sent home the same day to be sent back to the hospital on the 21nd with a sever bowel obstruction staying in the hospital until the 23rd. Was released to go home only to be brought back in on the 30th of Oct.. to have a stent put down my throat to divert a bile leakage into my intestents...Was released from the hospital again on the 3rd to be told I would heal from here to be rushed back 2days later on the 5th to have a tube ran straight thru my liver into the bile pocket released and on the 7th to be rushed in again on the 19th to get 2pints of blood and some type on probe into my lower stomach to have 80cc of bile sucked out of another bile pocket....Still do not have the answers as to whats next but what I do know is I have been thru pure hell for the last 5weeks...Can anyone tell me what else I have to look forward tooooo???/

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  5. I had this surgery performed in 1992. It was such a horrific experience that I almost never talk about it. I went in for a "23 hour" hospital stay. I had a surgery was and excellent reputation, who also served on the Board of the Florida Medical Association.
    Immediately after surgery they said everything went well, however my belly was on fire and I looked 12 months pregnant. My surgeon was going to send me home, and gratefully I insisted on staying one more day. My Urine was a brick red color, and I was told I had a right ruptured kidney, that I had probably had since I had been pregnant 2 years earlier. Right? I'm not going to feel that for two years. My doctor went on vacation, so on the third day of excrutiating pain, and being told to walk because it was gas, my surgeons partner told me I was over reacting because I was young. I was 25 and had given birth, so I knew pain. What is most painful is that I had objetive findings. My white blood count was very high, I had fever, ect... When my doctor returned he knew something was wrong and I was told they might not be able to save me. I was rushed for and exploratory laparotomy, where I was then told they fixed the problem. After that I went through what is called an ERCP, to long to explain, basically stent in bile duct. This worked for a couple of days, after which the bile filling my Jackson Pratt every half hour started to come out directly from my incision burning my skin. I also had the stent in my kidney as well. Back to the drawing board, stent in bile clogged with scar tissue, another ERCP, and continued stay in ICU because everything was failing. They didn't even remember to give me nutrition, so when I was going to be sent home, I was completely mal-nutritioned with no protien in my body. There is so much that happened it is hard to believe, except I feel lucky I survived. I had to return to hospital several times to suck rocks off of my liver. I know this is a long comment, but a wound was opened and it just had to say it. I pray for anyone who has to experience anything like this. I did see a couple of lawyers who said "Hey, your alive, and have no permanent damage", so move on with your life. Thing is my health has never been the same, not ever. Right now the lining of my stomach is very thin. I know the education doctors received for this surgery because for a while I worked at a company that sold the Lap equipment. The salesmen were not MDs and the surgeons practiced on foam dummies or pig over a 2 day serminar. I know it is too late for me, but if someone else has gone through this, pursue with as many lawyers as you need, because I didn't get so much as an apology, just a large medical bill.

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  6. I underwent lap chole in June 2009 and was readmitted 5 days later with jaundice and severe abdominal pain. After two days of more tests and more pain I was transferred to a tertiary center. They diagnosed the problem in the first couple of hours that I was there. I had biliary drains in place for 4 months until I underwent a Roux en Y procedure and a liver resection in which 1/4 of my liver was removed. I had drains after the surgery for 2 months. I was hospitalized 5 times in the course of treatment at the tertiary center. Lots of pain was involved. I too pray that no one else has to go through this. It is true I am alive and doing fairly well but the future is not clear. My alkaline phosphatase remains elevated a month after reconstructive surgery. I will need further evaluation if it does not normalize. I think that if the attorneys had this happen to them they would not feel the same about it. Only people who have gone through this can fully understand.

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  7. I also went in for a standard laparoscopic gall bladder removal surgery. The surgeon cut my main bile duct instead. He performed a Roux-en-y hepaticojejunostomy. I suffered for 2 years with the worst stomach pain/spasms you could imagine. They literally dropped me to my knees. I was misdiagnosed over and over. Told I had fatty liver and some kind of esophageal spasms going on. I finally had enough and went to a liver specialist. Within a few minutes he diagnosed the source of my pain and provided me the medicine that I needed to stop the pain. I had bile refluxing back into my stomach. Also, he performed a liver biopsy on me. It showed stage 2 hepatitis/liver disease already in less than 2 years since my botched surgery. I want to put an end to this for everyone else out there. Due to Tort reform, you can't hold the doctors responsible anymore. We need to stop the madness. Please visit my facebook page for Bile Duct Transection and join me if you have been damaged by these careless doctors. It should never happen to anyone and it needs to stop now!

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  8. For those of you who have had complications after laparoscopic gallbladder surgery, I am sorry. For those who have doctors that are unwilling to be up front about complications during surgery, I am sorry. For those, however, who have had a complication after laparoscopic surgery that was promptly identified and treated, then understand that not all complications are due to "botched surgery" and an uncaring doctor. Laparoscopic gallbladder surgery has been a Godsend to many patients and is performed safely over 98% of the time. Ask all of the patients who have a large incision under the right ribcage from their open gallbladder operation prior to the laparoscopic age how much fun it was to recover from those procedures. Not every complication is the surgeon's fault. "Putting an end to this" and "stopping the madness" and assuming that every doctor is an uncaring, money grubbing jerk is being just as ignorant as the surgeon that ignores all of your symptoms.

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  9. Anonymous post on Feb 20,2012 Just wanted to say unless you have suffered what looks to be a few of us you have no right to tell us how to feel. I know several people who had the same surgery as I had and had no complications. After reading all post after mine Nov 26 2009 I didn't see where they blamed all Drs. Just the one that did there surgery.Yes I do blame my surgeon for the pain I have endured over the past 2 1/2 years. I am still going through pain.Everything I eat either comes out from the top or the bottom if you get my drift. I understand accidents happen but to have a cancer Dr, which I don't have cancer do a gallbladder surgery is wrong on the part of the hospital and the Dr. doing the surgery. I ask many times what is going on, whats happening to my body? and all he would say is it was my fault because I had something call {DUCT OF LUSHCIA} not sure spelling in right. That 1 in a million people have that and it is a 3rd duct in which he did not see and he cut it. The part that upset me about all of it was the fact it took 6 surgeries, 2 blood transfusions and 8 hospital stays to find out and only because I pitched such a fit they brought the big wigs in from down stairs that made them explain what was going on. Understand when I tell you the other doctors after the 1st surgery didn't want to tell me what was going on and it was like pulling teeth to get "my surgeon" to sit still long enough to tell me the problem. The bile that "leaked"into my body was not there for a couple days but was there from Oct.19th until dec 21. That is 2 solid months. Yes this has attacked every vital organ in my body. It is said within 5years my organs will start shutting down. So unless you have walked in my shoes for a day don't you dare think it's okay to say or assume you have any idea of what I have suffered or will suffer for the rest of my short time of life. I have 7 grandchildren that I may or may not get to see graduate high school, get married or have children.All because of an uncaring Dr. Oh and the only "ignorant" person I have seen reading these post is YOU and YOU alone.

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  10. I understand what you are going through.Feb of 2011 my surgeon also cut my bile duct clean in half.He also tried to say I had a 3rd bile duct I think most doctors say that he also said i was too large it was very diffiuclt bla bla bla so why didnt he do angiogram or just open me up?.My Doctor pretty much knew he done it.Tried to feed my whole family of nurses a bunch of bologna until all 4 of us told him we were nurses.He admitted to making mistake 2 days later after my mother begged him for 2 days to send me finally sent me to UPMC a wonderful doctor Alan Tsung and his team after putting drains etc in to drain off the poisenous bile for about a week performed my life saving surgery to repair what my doctor had done.I was in UPMc for 3 weeks of recovery its been over a year.I still have pain on a daily basis where my huge 16 inch scar is.Also problems with digestion.I have to make a trip to pittsburgh once a year and medical bills of 300,000 dollars and if i devolop scar tissue/narrowing of my bile duct thats more surgery etc..This was one of the worst painful things i have ever experienced and I had 2 children one by c section and never ever had the pain i experienced with this.They will try to tell you that its a complication of surgery, but it isnt..Its malpractice if the doctor would of taken his time did an angiogram, or open cholestystectomy more than likely this would of not happen to me or any others.Yes people make mistakes, but if you can prevent a mistake wouldnt you do it?I pray for your recovery im so sorry you are going through the worst case scenario of this mistake..I have done tons of research since this happen to me in some states its considered malpractice in others its considered just a possible outcome/complication which i think is a bunch of bull..

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  11. I had an outpatient laparoscopic cholecystectomy on March 17th. The surgeon met with my caregiver right after surgery and stated everything went as well as expected and there were no complications. I came to in recovery with extreme pain and instead of going home 1.5 hours later, I barely made my way home after 6 hours. The nurse yelled at me for not saying I had problems with anesthesia. I don't have problems with anesthesia! 48 hours later I was just short of going into shock from the excruciating pain and immediately went to the ER. There my surgeon met with me and said, he was "afraid this would happen to me and that my initial gallbladder removal was complicated and there were problems with it adhering to surrounding organs". He initialy said he thought he may have perforated my duodenum and after 24 hours of tests and scans they identified a leak. I had an emergency laparotomy where the duct was repaired and 2 stents were added.

    I understand there is a potential risk of this happening. I am more disappointed in the fact that my surgeon failed to explain that the initial surgery was complicated. He only fessed up once it became a life and death matter. Over the next week I spent in the hospital I received conflicting stories and apologies from the surgeon who admitted this never should have happened to me.

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  12. THE THING I THINK WE ALL HAVE IN COMMON IS THE TRAUMA OF THE SITUATION. NOT BEING LISTENED TOO WHEN YOU TELL DR'S AND NURSES YOU ARE IN INTENSE PAIN. HAVING THEM IGNORE YOU AND LEAVE YOU ON YOUR OWN. LIE TO COVER UP THEIR MISTAKES. I AM SO THANKFUL FOR THE GOOD CARE I RECEIVED AFTER MY HUSBAND INSIST WE GO TO A DIFFERENT HOSPITAL. THEY TREATED ME WITH RESPECT AND COMPASSION. I ALSO FIND IT HARD TO TALK ABOUT. I WISH YOU ALL WELL AS YOU CONTINUE TO RECOVER BE IT PHYSICALLY OR MENTALLY.

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    1. My daughter is going through what all you people have gone through.She had her gall bladder removed which the surgeon said was easy.Even before she was discharged she was in severe pain and vomiting ,she was still sent home. Within 24 hours she went into septic shock and nearily died. Her bile duct was leaky badly and still is leaking after 2 months. She has a blood fungul infection that started from her bile duct leaking still on dangerous antibiotics after 2 months . "Which by the way gives you liver decease". She has gone through so many procedures and still no sign of being fixed. Mind you she,s been in hospital the whole 2 months. She has had 3 stents put in and none have taken. She cant eat,she has lost 4 stone in weight. Everyone that,s talking on here is right these doctors and nurses do not listen to the patient when they tell them that they are so ill that they can, stand up. As a mother i did my research and let those egotistical doctors know that, i know about medicine myself. When i started to discuss what i know and what procedures and problems my daighter was going to have in her future life they suddenly started to treat her better.. My daughter should never have had this operation she had 1 stone in her gall bladder. She is still so ill. Always ask about the doctor that a doing your surgery. Make sure that he has done hundreds of surgeries. Because if he,s only done a couple of operations under supervision and your the patient that hes doing the first time alone then your in dangerous hands. These doctors need to stop chasing money and respect their patients. Some of these surgeon are so busy they can,t possibly be doing there surgery properly.

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  13. My gallbladder was taken out in 2006! Things were fine until Oct. 2011...I felt like i was having my gallstone attacks again...After an mrcp and ct scans, a stone and sever scarring was found in the cystic duct ( apparently shouldn't cause this)...The Dr. is hesitant to go in on an open surgery and take it out as he doesn't want to cause me worse symptoms or complications....I don't even know what to push for except my one live count is going higher...

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  14. I know exactly how everyone feels.My lawyer said I couldnt sue because their medical expert said the doc did what she was supposed to do to fix the problem.That was in 09 and I still have a bile leak,2 hernias and kidney damage.I was finally approved for disability a few months ago.Now I have to find a good doc that knows how to fix everything.And it is scarry as hell not knowing what is going to happen or what kind of damage the leak is doing to my insides.Good luck everyone!

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  15. I HAD MY MAIN BILE DUCT CUT OFF TOLD I HAD A EXTRA APPENDAGE GAL-BLADDER SURGERY LAPROSCOPIC MOST PEOPLE COULDNT IMAGINE PAIN EVEN STILL TOLD FOR FIVE DAYS IT WAS GAS BY MY SURGEON WENT TO HOSPITAL TRIED TO GIVE ME AN ENEMA HAVE LIVER FAILER NOW 37 YRS OLD SPEND MOST DAYS WISHING THE PAIN WOULD STOP CANT GET HELP NO INSURANCE BEEN FIVE YRS JUST FOUND OUT ABOUT LIVER MAKES U WANT GOD TO TAKE U BECAUSE U GET TIRED OF PAIN

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  16. Living in this Hell, as i write this. So true, about the common bond of the trauma. I am a mess. Had Lap Coly on Aug 30, 2012. I never saw surgeon when i woke. seems there was a vacation to get to. I could not get comfortable at home. Called the Service on Sept 1st am. They tried telling my husband it was the gas from surgery. I could not get words out..never had pain like this. I went to the Er at hospital where original surgery was done. They did not manage my pain adequately- as i am a fibromyalgia sufferer..i have taken pain medications on and off for years. this makes acute pain, tricky to manage. take the oversensitive nerve response...i was in hell. They dragged me along thanks to Labor Day weekend. CT did not show fluid. MRI showed Fluid. ERCP..stint put in. Sent me the next day for drain. They did CT..no fluid. The next 3 1/2 days were spent trying to up my potassium, and blood count. They sent me home. I was at another hospital, within 24 hours, after the pain came back (i was on lower dose pain meds at home..it had never gone away) The second Hospital found bile leak with CT and Ultrasound, after the night in ER..where the doctor on, had no time to see me..and was not comfortable giving meds for pain...it was again, hell..finally was admitted and had JP drain put in. THIS IS NOT A GREAT EXPERIENCE < AWAKE.!!!!! I was kept for 4 days..and sent home when they could get my numbers up. I had the drain removed yesterday, the 24th of september. There was also another fluid pocket that developed, away from the drain catheter. That had to be aspirated. THIS IS NOT A FUN SITUATION>>WHEN AWAKE! I was told i would feel so much better. This is not the case. It is painful if i breath in. I am scared out of my mind that more fluid will build up. They told me this is a possibility..especially when i have stint removed. I am not sure i am going to get over this trauma any time soon. non of this was talked about before the Gallbladder was removed. The forst weeks of school with teenage girls and a mom in the hospital, is not a great situations. Those girls having anxiety and panic attacks, because nothing is right in their world..seems unnecessary. How can i tell if this was a surgical error...never being a litigious type..this is a whole different ballgame. My Husband has not been into the office since the 29th of Aug. I am nervous that he has to go in tomorrow. I have yet to drive. Afraid i wil take a deep breath..yawn, sigh or burp..and cause stabbing pain in my side...distracting me from the road. MY family needs their mom and wife back. When will i feel like it is going to be ok...and no one had screwed up? Oh...the hospitals were so off base with discharge paperwork. none of the right Doctors were on it. It took 9 days to get dressing changed on drain!!!!! the nurses and aids did not know how to work bed....i had one shower in 13 days...as shower was broken....i have lived in hell for 28 days...HELP!!! when will it and and is someone to blame?

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  17. My 17 year old daughter ...she was 16 when she had her gallbladder removed. During the procedure the common bile duct was cut (hers was the size of a strand of hair which menas it was underdeveloped when she was born. days after gallbladder removed she turned jaundice and dark orange urine. Sh ewas rushed in to emergency repair surgery a Ruen Y. this was in January 2012. In June 2012 the new duct became blocked with scar tissue and liver leverls extremly high went to the ER where she was admitted and a ERCP performed (no stents put in). In August she had to go back in because it became blocked again ..this time 3 stents were placed. In October she had to go back in as she started having the same symptoms over again. Went in for another ERCP only to find out that the stents had become dislodged and she had passed them. less than 3 weeks later she is doubled over and in severe pain around the same area. All this has happened of a course of 10 months. too much for anyone to go through, much less a child.

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  18. I'm 18 years old, sept 26 of 2012 I had a lap choly. When I came out of surgery I was told I had a very sick gallbladder and that my liver was slightly leaking bile so I had to keep the JP drain in for a week. My hospital stay was only 3 days long. It wasn't until a week later when the Dr realized there was something wrong, the JP drain hadn't stopped draining yet. He ordered an ercp. When I woke up I was excited thinking I wouldn't have to deal with the JP drain anymore... no such luck, I was told they couldn't get the stent in and they didn't know why. I was sent to another hospital where they tried to put another drain in my liver, but failed. so they told me they weren't going to do anything. I was told my bile duct had been clamped and severed. They told me they were going to wait until I got sick to do anything further. But no way we were letting that happen. We went to a different Dr, the best of the best. It was there I learned that my liver anatomy was different than normal, and there was Nothing that could have been done to produce a different outcome. I had 3 more drains put in. They drove me crazy. I spent about 2 1/2 months in the hospital because the drains kept coming out of place. I had multiple very painful procedures. When the time finally came for surgery I was ecstatic. But once again things didn't go as planned. During the surgery they had to remove half my liver. I came out of surgery with two more drains, both of which I had to keep for about 2 weeks. Now I'm struggling to get enough protein to regrow my liver. I'm always exhausted. And I have random severe pain. I'm only about 2 months post op so I'm still in the danger zone but I'm hoping things get better... I just need a break...

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  19. Feb. 2013 had gallbladder removed after five days of complaining to the doctor and him insisting it was just gas from the surgery I finally convinced him to see me..not even five minutes after going into his office my papers were being made to go into the hospital..my Surgeon never said a word of what happen not even an apology . I had three operations and a 6 inch scar a drain ..today is may 3 had two appointments with him and he has yet to explain what happen..I saw him once at the hospital because while I was recuperating he was on vacation..made me mad..honestly this is a nightmare ...

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  20. Thanks everyone for your very informative comments. I am about to have a Lap Chole Open Hepaticojejunostomy and you have made me aware of what can go wrong. Perhaps I should have my lawyer video the operation to help with my claim for compensation.

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  21. HERE`S one with a twist. my husband had gastric by-pass in 2010. it went great. 2 yrs later, lower esophagus & abdominal pain. MD`s see him, cant figure it out. it gets worse...many months later, during another ER visit they discover gallbladder wasnt functioning b/c two stones stuck in bile duct. All previous tests said no. NO surgeon would touch him due to the already altered digestive system. They took out gallbladder on 10/14/13. symptoms continue...They keep ordering swallow tests.Took him back to the ER & was admitted.on 2/11/14 & was sent hours away to have ERCP done and surgery to remove stones. they sent him back in ambulance 2 HOURS after surgery. the pain and nausea, and violent retching never stopped, not even during hospital stay. he was discharged 2/15/14 over loaded with pain meds, fluids and B/P meds i almost lost him that night. it is now 5/15/14 and it is still going on. He can only sit & retch with dry-heaves multiple times every hour for over 215 days now with no end or help in sight. I've begged his Gastro. MD to call out to other gastro. MDs and/or get surgical residents to research if he doesn't have time...he`s done nothing except refer him to other people...who don't know/ want to help him either!

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  22. I had my gallbladder removed in 1990 the big scar because "I had a malformed bile duct since birth" and the doctor had to fix it. Stayed in 30 days in pain, sick and could not eat. I finally got well enough to go home. I was back in a few weeks so he could drain an abscess another hospital stay pain and sick. Two weeks later same thing. Then I went a year and a half okay. I started feeling bad yet didn't think much of it until my family told me I was past yellow and into green and they took me to the E.R. Completely stopped up bile duct and liver abscesses. Local hospital tried stints and meds then told my boyfriend to call in my family to say goodbyes. I hung on and they ended up sending me to a hospital in Dallas where they drained the bile duct and liver gave meds and sent me home. Two weeks later same thing. This time I had drain tubes for six months. Now let me add this each time they wanted to know how much I was drinking alcohol and I said none so they wanted to know what street drug I was on. I told them not one and they acted like they didn't believe me. So I go for over ten years just fine and then bam my liver was acting up it was causing my ammonia levels off the charts. This causes you to go loopy as hell you don't know who you are, where you are, the day, month, year, president nothing. For a year I fought this 10 times in the hospital 7 they told my loved ones I wouldn't make it through it. You hallucinate get paranoid it is hell. Now I live on a liver antibiotic and lactulose which binds with the ammonia and removes it from your system. Let us just say it is a super laxative. I still get asked if I got it from alcohol or drugs which pisses me off. No I got it from a doctor I trusted who has ruined my life and probably has taken years off my life. I feel for anyone that has had their gallbladder removed and had any trouble due to it. May peace and light always be with you.

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