What could be the causes of pain after cholecystectomy?

Question

Hello doctor,

I had two surgeries: gastric bypass and laparoscopic cholecystectomy. After my laparoscopic cholecystectomy, I noticed pain on my right side, which appears noticeably larger. I experience pain there, especially when lifting. My surgeon has opened this incision twice.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

When you mentioned that your surgeon opened the incision twice, I assume you are referring to the port sites from laparoscopic surgery, not open surgery. In the image (attachments removed to protect the patient’s identity), you are pointing to the right lateral region and the right lower quadrant of the abdomen.

Please answer my questions: Is the pain continuous or intermittent? How often do you experience pain? If the pain comes and goes, how long does it last? Is the pain related to food intake? If so, which food items cause the pain? Is the pain associated with vomiting, loose stools, constipation, or fever? Do you have burning while passing urine, abdominal bloating, or jaundice?

The pain is located well below the gallbladder area, so it may not be related to laparoscopic cholecystectomy complications. Possible causes include a port site hernia, stones in the right ureter (the tube carrying urine from the right kidney), adhesions causing intestinal colic, or food intolerance. Please answer the above questions; they will provide more information regarding the cause of the pain.

I suggest you get a complete blood count, a comprehensive urine examination, and an ultrasound scan of the abdomen.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

If you can feel a lump that is tender, the following possibilities exist:

First, it could be an irreducible port site hernia. The lump may enlarge when you cough and could disappear when lying down if it is a reducible hernia.
The second possibility is a localized abscess, which could occur if a gallstone accidentally slipped into the wound during retrieval.

Please get an ultrasound scan of the abdomen and specifically ask the radiologist to look for a hernia at that site. Alternatively, consider getting a CT (computed tomography) scan of the abdomen with oral and IV (intravenous) contrast. If it is a hernia, surgery may be necessary. Hernias are rare after laparoscopic surgeries, but they are still possible.

I hope this helps you.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

Having a painful lump at the port sites is normal if it persists for up to one month after surgery. During the healing process, you may notice a tender lump, but it should gradually diminish, and in most people, it disappears by the end of one month. Pain also typically decreases, and by two weeks to one month, it should no longer be painful. In your case, it has been nearly three months since your last surgery, yet you still have pain and a lump, which is not normal.

If your surgeon used non-absorbable sutures to close the port, some patients may experience pain for almost six months; however, the lump should not remain that long.

It is advisable to rule out any problems by getting an ultrasound scan done. If the scan shows no issues, you can wait for the pain to subside. As mentioned earlier, avoid weightlifting for some time. If the scan is normal, you can use a belt for support while lifting weights, but I recommend taking a break from any exercises involving the abdominal muscles.

Thank you.