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Bile duct cancer

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Potential side effects of surgery for extrahepatic bile duct cancer

Side effects can occur with any type of treatment for extrahepatic bile duct cancer, but not everyone has them or experiences them in the same way. Side effects of surgery will depend mainly on the:

  • type and extent of surgery
  • person's overall health

Side effects can happen any time during surgery. Some may happen during, immediately after or a few days or weeks after surgery. Most side effects go away after surgery. Late side effects can occur months or years after surgery. Some side effects may last a long time or be permanent.

It is important to report side effects to the healthcare team.

Pain

Pain often occurs after extrahepatic bile duct surgery because of trauma to the tissue during surgery, especially with major surgeries like a liver (hepatic) resection and pancreatoduodenectomy (Whipple procedure). Pain-relieving medications are used to control pain. It may take time for pain to go away after surgery, depending on the procedure done and how the person heals and tolerates pain. Talk to the doctor or healthcare team if pain does not go away or medicines do not relieve the pain.

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Nausea and vomiting

Nausea and vomiting can occur because of the effects of general anesthesiaanesthesiaThe loss of some or all feeling or awareness. used during extrahepatic bile duct surgery. The healthcare team will often give medicines to prevent and control nausea and vomiting. Nausea and vomiting are usually temporary side effects and often go away a few days after surgery.

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Infection

Some people develop a wound infection after extrahepatic bile duct surgery. Antibiotics may be used to help prevent or treat an infection. Wound infections are a temporary side effect of surgery.

Infection can occur when a biliary stent or drainage catheter becomes blocked. Bile can build up and cause the bile duct to become inflamed (cholangitis).

Report signs of infection to the doctor or healthcare team. They include redness, pus, foul-smelling drainage, increased swelling or tenderness of the incision site and fever.

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Bleeding

Bleeding or hemorrhage can occur if a blood vessel is not sealed off during extrahepatic bile duct surgery, or if the person has a blood clotting disorder. The liver, which has a very rich blood supply, is very close to the proximal bile duct. There can be some bleeding from the proximal bile duct after surgery, especially if part of the nearby liver is removed to treat perihilar (proximal) bile duct cancer. Sometimes drugs are given before surgery to help the blood clot.

Nursing staff frequently check bandages and drains for excessive bleeding right after surgery. If bleeding occurs and is severe enough, the surgeon may have to take the person back to the operating room to find where bleeding is coming from and to stop it.

A small amount of bloody drainage may be expected after surgery. Report excessive amounts to the doctor or healthcare team.

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Lung problems

Lung problems can occur because the incision for extrahepatic bile duct surgery is often in the upper abdomen. Other factors, such as pre-existing lung problems or smoking, can also contribute to lung problems.

One of the main lung problems that may occur after extrahepatic bile duct surgery is pneumoniapneumoniaInfection of one or both lungs caused by bacteria, viruses or fungi. Signs and symptoms include fever, chills, cough with sputum (phlegm), chest pain and shortness of breath.. Frequent deep breathing and coughing, and turning in bed help to reduce the chance of lung problems after surgery. People may be given a special device called an incentive spirometer to breathe into to help them take deep breaths. Stopping smoking before surgery helps to prevent lung infection.

Report shortness of breath, fever and coughing to the doctor or healthcare team.

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Blood clots

A blood clot in the leg is called a deep vein thrombosis (DVT). One reason a DVT can occur right after extrahepatic bile duct surgery is because the person is not moving around much, so blood can collect in the legs. Other factors also contribute to DVT. In the most serious cases, a blood clot can break away and travel to the lungs (called a pulmonary embolus). This causes shortness of breath and affects the ability of the blood to get oxygen from the lungs.

Frequent position changes, leg and ankle exercises, and walking soon after surgery help reduce blood clots. Low doses of a blood thinner, such as heparin, may be given to help reduce the risk of blood clots in people at risk for developing them. If a person smokes, stopping smoking before surgery helps to reduce the risk of blood clots.

Report shortness of breath and any redness, swelling, pain or cramps in the calf of the leg to the doctor or healthcare team.

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Diarrhea

Some people who have extrahepatic bile duct surgery will have diarrhea or more frequent bowel movements, especially if bile is redirected to flow directly into the small intestine. Stools also tend to stay in the bowel for less time.

Diarrhea may occur immediately after surgery. It can improve with time, but diarrhea can also last for many years. There are ways to help control and treat diarrhea.

  • The doctor may recommend anti-diarrhea drugs to slow down the bowel.
  • Some changes in diet may help with diarrhea.

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Cholangitis

Cholangitis is an inflammation of the bile ducts. It occurs when bile doesn't drain properly and causes an infection. This can happen when a biliary stent or drainage catheter becomes blocked. Doctors may prescribe antibiotics to reduce the inflammation. They may also remove and replace a blocked biliary stent or catheter.

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Bile leak

Bile leak or bile duct injury is a problem that can occur after extrahepatic bile duct surgery. Bile leak or bile duct injury can cause abdominal pain. The doctor may do an endoscopic retrograde cholangiopancreatography (ERCP) to find the source of the leak and place a stent to help drain the bile. Surgery is sometimes needed to repair the leak or injury to the bile duct.

An anastomosis is the area where the remaining bile duct is surgically connected to another structure, such as the small intestine. The stitches (sutures) holding the 2 ends together may break or come apart. When this happens, fluid (such as bile) leaks out into the abdomen. This is an anastomotic leak, and the surgeon needs to repair it.

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Digestion problems

Problems with digestion can occur if the person had a pancreatoduodenectomy (Whipple procedure). The pancreas makes digestive enzymes, and removing part of the pancreas can cause a decrease in the amount of enzymes. About 1 in 3 people who have had a Whipple procedure need to take enzymes to help them digest food.

After surgery, people may not feel like eating, or they may feel bloated or full faster. It may be easier for them to eat small meals throughout the day rather than having 3 large meals each day. Snacking between meals can also help the body absorb food and lessen bloating or feeling too full.

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Problems with blood sugar levels

People may have problems with blood sugar levels when part of the pancreas is removed during a pancreatoduodenectomy (Whipple procedure). The pancreas produces insulin, which is needed to control blood sugar. People may develop diabetes if part or all of the pancreas is removed. The chance of developing diabetes is greater if the person had blood sugar problems before surgery. The healthcare team will monitor the person's blood sugar level. Changes in diet and medicines may be needed to control high blood sugar.

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