Causes and Prevention of Recurrent Pain after Laparoscopic Cholecystectomy / 中国微创外科杂志

ABSTRACT

Objective To investigate the causes and preventive measures of recurrent pain after laparoscopic cholecystectomy (LC). Methods From January 2000 to January 2006,168 patients developed recurrent pain after LC. The pain was caused by non-incisional wound,postoperative complications,relapse of preoperative symptoms,cholecystitis complicated with gallbladder stones,or other diseases. The data of the cases were reviewed in this study. Results Among the cases,24 patients had neck and shoulder pain,and 5 cases complained of puncture pain; 71 cases showed consistent abdominal pain,among which 28 had bile leak; 23 developed secondary common bile duct stones,6 suffered from acute pancreatitis,and 8 had residual cholecystitis or cholecystic stones; inferior hepatic space inflammatory fluid was detected in 5 cases,duodenal bulbar ulcer in 1 case; and 32 cases suffered from paroxysmal pain in the abdominal cavity,9 of them were diagnosed as bowel hyperperistalsis,and 23 had biliary dyskinesia; 31 patients had jaundice complicated with abdominal pain,right focal dilation of the intrahepatic bile duct was detected in 7 of them,residual stones in the extra hepatic bile duct in 11 cases,ampullary carcinoma in 2 cases,carcinoma in the inferior bile duct in 1 case,and ascariasis of the biliary tract in 2 cases; two patients developed abdominal pain because of abdominal distension,and one was induced by severe nausea and vomiting. In this series,the symptoms were relieved in all of the cases,86 of them were cured by a second operation or ERCP plus EST,and the other 82 received conversational therapy. The patient was followed up for 1 to 36 months,during the period,no complications occurred. Conclusions The causes of recurrent pain after LC involve in each component of perioperation procedures.