Health Insurance Now !

Author Archive

Bile duct injury The major risk during gallbladder surgery is injury to the main bile duct. This is rare (1 in every 300 operations) but does require a major operation to repair the problem. All surgeons are aware of this risk and work very hard to avoid the problem.

Other side effects in the abdomen There are other side effects from cholecystectomy such as a leaking of the bile but these are not usually apparent until after discharge of the patient. Patients should consult their general practitioners at once if they develop a yellow colour to the skin (jaundice) or find they are having steadily increasing abdominal pain.

Diarrhoea A small percentage of patients notice their bowels become looser after cholecystectomy. This is usually very minor but occasionally medication is needed to control this effect.

Deep vein thrombosis (DVT) DVT is a possible problem after cholecystectomy but is uncommon. If a patient is at particular risk (having had a thrombosis before or if they are taking the contraceptive pill) then they should tell the surgeon about this and special precautions will be taken to reduce the risk. Moving the legs and feet as soon as possible after the operation and walking about early all help to stop thrombosis occurring.

General anaesthetics ” the risks A general anaesthetic comes with some risks which are usually low but may be more likely in people with other medical diseases:

Common temporary side-effects (risk of 1 in 10 to 1 in 100) include bruising or pain in the area of injections, blurred vision and sickness (these can usually be treated and pass off quickly.

Infrequent complications (risk of 1 in 100 to 1 in 10,000) include temporary breathing difficulties, muscle pains, headaches, damage to teeth, lips and tongue, sore throat and temporary difficulty speaking.

Extremely rare and serious complications (risk of less than 1 in 10,000) include severe allergic reactions and death, brain damage, kidney and liver failure, lung damage, permanent nerve or blood vessel damage, eye injury and damage to the voice box. These are very rare and may depend on whether the patient has other serious medical conditions.

The benefits of cholecystectomy via the laparoscope The benefits of laparoscopic cholecystectomy have meant that surgeons have changed almost completely from open operation. A speedier recovery time, lower infection risk, reduced post-operative pain and very limited scarring are the main reasons this operative technique is preferred. After 24 hours most patients are now mobile and able to go home, returning to work by seven days. Laparoscopic cholecystectomy is no longer a new operation and surgeons are skilled at doing this.

What to do if there is a problem? If there is an acute problem such as fever or a discharging wound it is best for patients to contact their own family doctor first. The doctor may suggest the patient sees the surgeons at the hospital and if this is necessary they will make the arrangements. If patients are unable to get urgent medical help from a general practitioner they should attend the Emergency Department of their nearest hospital.

Post cholecystectomy syndrome (PCS)

Post cholecystectomy syndrome (PCS) describes a group of symptoms which can present after cholecystectomy. The typical symptoms originally attributed to the gallbladder may continue after the operation or new symptoms can develop which would normally be thought to be due to gall bladder problems. This syndrome will also cover symptoms brought on by gallbladder removal itself. The cause of PCS is thought to be an alteration in the bile flow because the reservoir for bile, the gallbladder, has been lost. There may be an increased flow of bile into the upper digestive tract, adding to inflammation of the oesophagus and stomach. Secondly this may have an effect lower down in the digestive tract, causing diarrhoea and sharp abdominal pains.

Typical average prevalence of PCS is 10 to 15 percent of cases of cholecystectomy, with attentive communication and questioning required both to explain the potential difficulties pre-operatively and to elicit the somewhat subtle symptoms later. Overall opinion is that the more securely the diagnosis is made initially the less likely PCS is to occur.

I have covered the rationale and aims of performing routine exercises for the spinal joints in a previous article, now I will move on to the performance of the spinal exercises themselves. Patients should follow the exercise instructions and perform the exercises smoothly with even timing through the range, holding for a short period at the end of the joint ranges. A moderate degree of pain may well be acceptable as long as it is not too severe and does not last long after the performance of the exercise. Doing the exercises daily is key to managing a back pain problem.

Leg flexion to the chest In supine hold on to your knee and pull your thigh up to your chest, keeping it at the full extent for a few seconds, with the other leg remaining flat down. The lumbar spinal joints, ligaments and muscles, hip and sacroiliac joints are mobilised during this manoeuvre.

Bilateral knees to chest stretch Lying flat on the back, bend your knees and pull on your shins, pulling your thighs up to the trunk. This is less stretching for the sacroiliac and hip but gives a stronger stretch to the low back structures including the ligaments, muscles and joints.

Stretching in the Child Pose This pose stretches out the whole of the spine by using the bodyweight to stretch the back out over the bent thighs in a kneeling down position, ending up in a curled up position with the face near the ground.

Squatting This is a much more forceful movement which can be very useful after a lot of sitting. We are often taught to perform extension movements after a period of flexion such as sitting, but this movement can be just as successful in restoring spinal comfort after a lot of sitting down.

Squat right down until your thighs are against your calves, using a block under your heels if you need to maintain balance. Staying down in that position for half a minute, allowing the lumbar spine to flex out, can be performed at times or three times in a row with rests between.

As this is a relatively severe exercise it would be useful to work at the earlier flexion exercises in lying first before tackling this.

Lying on the front Sometimes the ability to extend the lumbar spine is restricted and then prone lying, lying on the front, is a useful starting exercise as even this can stress the joints when they are stiff. The back is more extended in this position that it appears on the surface.

Prone Lying Leaning on Elbows Once the patient can maintain prone lying easily they can progress to leaning up on the forearms and looking forwards. This pushes the lumbar spinal structures into further extension but can be stressful for the back so should be limited to short periods of time.

Repeated Extension in Prone McKenzie technique is aimed at disc related problems such as derangement and dysfunction and is thought to affect the disc mechanics. Lying on the front in the press up position the patient straightens the arms and allows the back to assume a highly extended position by keeping their hips down on the surface.

This exercise can be aggravating as it is a strong passive extension movement, so physiotherapists test the exercise carefully to make sure there is a positive response before recommending it.

Knee roll exercise for rotation Lying flat on the back with the knees bent and the feet on the surface, the knees are rolled side to side whilst being kept together. The movement is taken as far as the joints will comfortably go and a little further. The lumbar spine has very limited rotation but other spinal structures may be restricted and respond to movement.

Mobilisation stretches of the lumbar spine This is a strong stretch of the lumbar spine and could aggravate the pain if easier stretches have not been performed earlier. The patient holds onto one bent up knee with the opposite hand and pulls the knee over towards the hand side, allowing their shoulders to remain flat so the stretch is concentrated on the low back