Q. I get pain on my right side after laparoscopic cholecystectomy. Please help.

Answered by
Dr. Amar Vennapusa
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 26, 2020

Hello doctor,

I had two surgeries gastric bypass and laparoscopy cholecystectomy. After my laparoscopy cholecystectomy, I noticed a pain on my right side and is noticeably bigger. I get pain there, especially with lifting. My surgeon opened this incision twice. Please help.

#

Hello,

Welcome to icliniq.com.

When you said your surgeon opened the incision twice, I suppose you refer to port sites of laparoscopic surgery, not open surgery.

In the image (attachment removed to protect patient identity), you are pointing to the right lateral region and right lower quadrant of the abdomen.

Please answer my questions. Is the pain continuous or coming and going? How frequently you get paid? If the pain comes and goes, how long does the pain stay? Is the pain related to food intake? If so, what are the food items that cause pain? Is the pain associated with vomitings or loose motions or constipation, or fever? Do you have burning while passing urine, or abdominal bloating, or jaundice?

Pain is well below the gall bladder area. So it may not be a complication related to gall bladder surgery. Possibilities are port site hernia, stones in the right ureter (urine tube coming from the right kidney), adhesions with intestine colic, or food intolerance. Please answer the above questions. It will give more information regarding the cause of pain.

You will need:

1. Complete blood picture.

2. Complete urine examination.

3. Ultrasound scan of the abdomen.


Investigations to be done:

If needed CT scan abdomen and pelvis with oral and IV contrast after doing serum creatinine can be done.

Differential diagnosis:

Right ureteric colic. Intestinal colic due to adhesions. Port site hernia.

Probable diagnosis:

Right ureteric colic. Intestinal colic due to adhesions. Port site hernia.

Preventive measures:

Avoid oil, spice, and chilly foods. Take more water, fruits, and vegetables. Avoid foods that cause food intolerance and pain.

Thank you doctor,

My pain is more when I do a lot of lifting at work. I do a physical job that involves a lot of lifting and pushing/pulling. I have pressed up against the area, and there is a slight lump there and a weird bulge underneath. I do get constipation, but I have been taking fiber and probiotics, and it is helping.

The pain is not from food intolerance. It is tender after a lot of lifting, no burning with urination.

#

Hi,

Welcome back to icliniq.com.

If you can feel a lump, which is tender means, the following are the possibilities.

First is irreducible port site hernia. The lump will become big when you cough, and it may disappear on lying down if it is a reducible hernia.

The second possibility is a localized abscess if any gall stone accidentally slipped into the wound while retrieving.

Please get an ultrasound scan of the abdomen done and specifically ask the radiologist to look for the hernia in that site. Alternatively, please get a CT scan of the abdomen with oral and IV contrast. If it is a hernia, you will need surgery.

Hernias are rare after laparoscopic surgeries but still possible.


Differential diagnosis:

Port site hernia. Localized abscess.

Probable diagnosis:

Port site hernia.

Treatment plan:

Investigations to confirm the diagnosis.
If it is a hernia surgery is needed.

Preventive measures:

Avoid heavy weight lifting until the problem is rectified.

Thank you doctor,

Is it normal to have a lump or bump near an incision following a laparoscopic surgery? I plan on following up with my surgeon, but his nurse insists it is normal and can take a while to go away.

#

Hi,

Welcome back to icliniq.com.

Having a painful lump at the port sites is normal if it is present until one month after surgery. When ports are healing, you may notice a tender lump. But that will come down slowly, and in most people, it will disappear by the end of one month. Pain also gradually comes down, and by the end of two weeks to one month, it will not be painful. In your case, it is nearing three months since your last surgery. Still, you have pain and a lump, which is not normal.

If your surgeon used non-absorbable sutures to close the port, some might feel pain for almost six months. But lump will not be there that long.

So it is always better to rule out the problem by getting an ultrasound scan done. If the scan does not show any problem, then you can wait for the pain to subside. As suggested earlier, avoid weight lifting for some time. If the scan is normal, you can use a belt to support while weight lifting. But I suggest you take a break from any exercise involving abdominal muscles.


Probable diagnosis:

Already mentioned

Preventive measures:

Avoid weight lifting for some time.


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