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Roux N Y Surgery during Gall Bladder Removal
Every year many thousands of people have a gall bladder removal due to stones or other types of gall bladder disease. Generally it is a surgery done by laparoscopy and is without incident. I had felt so confident about the procedure that when my husband had to have his gall bladder removed I didn't take off from work to go with him. Itís a revolving door procedure these days after all. He would not need me and I would not be of much help.
That is until the whole surgery turned into one big mess. It seems that his gall bladder was much more ill than they had anticipated. During the laparoscopic procedure the common bile duct was cut unintentionally. This turned the whole surgery into one of severity. Thank god we lived in a big city with a multitude of health professionals on hand. It only took one phone call to get a liver transplant specialist in the operating suite within an hour.
And of course I left work immediately when I received the call. A surgical incision was now required that was 7 inches long and a G.I. plumbing expert of significant caliber to take the task on. Once the common bile duct is cut there is little to do to repair it. It now needs to be rerouted.
First the gall bladder had to come out and shortly after surgery I was shown a photograph of what the doctor was up against. The bladder looked like an inflated black prune and they told me that it had what appeared to be gangrene. If they the common bile duct had not been cut and the laparoscopy surgery had gone as planned it was now surmised that the gall bladder would likely have ruptured when it was pulled through the small laparoscopy incision, leaving behind a toxic situation in the abdominal cavity.
Should I say thank god for small miracles and mishaps?
Once the gall bladder was removed it was now necessary to hook backup the common bile duct. But to what, that is the question in my mind.
The common bile duct runs from the liver to the duodenum. Along its way, closer to the duodenum the duct from the pancreas merges the common bile duct to form what is called the ampuella of vater. In this common passage bile and digestive enzymes flow into the duodenum. This common bile duct, now severely damaged needed a new pathway.
The liver transplant expert is a few leaps above the standard GI surgeon. He knows all about the internal plumbing and how it can be manipulated in adverse situations. Fortunately the common bile duct had a stem still attached to the liver that was in good shape. This remainder was about one inch long.
The surgeon decided to attach this stem to the intestine just south of the duodenum. He also had to make sure the Ampulla of vater's bile duct portion was closed off and that the ampulla of vater was still in good shape.
It was an unexpected and tense situation. Fortunately my husbandís GI surgeon had the good sense to know he was in trouble and fortunately he knew just who to call.
After the 5 hour surgery was complete the liver transplant surgeon met with me and told me that he does about 14 of these procedures called Roux n y a year, most of which are life lighted into the city from around the nation. He also said that all went well and that he anticipated a good outcome but that there were a few long term considerations to note.
When this type of roux n y is done there is the possibility that a reflux of digestive fluids could back up into the liver. The symptoms are a sudden flu like feeling and possibly some upper right abdominal pain. If this should happen Levaquin is to be taken immediately and then a visit to the doctor as a liver infect could be in progress. He said that it is rare but it is a possibility. We carried around a bottle of Levaquin for a long time but it never happened. The last few years we don't even think about it.
Now, over six years down the road all remains well. Digestion in general is good and there is no difficulty eating a high fat meal that some people have after a gall bladder removal but on occasion my husband gets fairly acute abdominal pain in his intestines, south of the stomach. This is not related to eating fats and just what causes it we are not sure but it is related to eating in general. The cure is a simple cup of peppermint tea.
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