Problems after bile duct cancer surgery
Like all operations there is a risk of problems or complications after surgery to remove bile duct cancer. Most complications are minor but some can be serious.
Before offering you surgery, your surgeon makes sure the benefits of having the operation outweighs the risks. Discussing the risks with your surgeon can help you decide whether to have surgery or not. When the aim of the operation is to try to cure the cancer, you and your surgeon may feel it is worth taking some of the risks.
If the cancer is in the intrahepatic or perihilar bile duct, your surgeon normally removes part of your liver. If it is in the distal bile duct they remove part of your pancreas and small bowel.
Some of the complications are the same for both types of surgery. These include:
Infection
There is a risk of infection after any operation.
You can get an infection in your wound. This makes the area around it red and hot. The wound may also leak fluid and you may get a high temperature.
You can also get an infection if fluid or blood collects in your tummy (abdomen) after your surgery. Sometimes you may get an 
.
Doctors treat infections with antibiotics. You have them through a drip into your bloodstream or as tablets. Which way you have the antibiotics depends on what is causing the infection and how bad it is.
Your doctor will normally drain an abscess or any fluid that has collected inside your abdomen. They use an ultrasound or CT scan to help them guide a needle or tube into the fluid or abscess to drain it.
Chest infection
A chest infection is a common complication after many operations. It happens because you are not moving around or breathing deeply enough after your surgery. Moving about and taking deep breaths helps you to keep your lungs clear. If you are not able to do this, what you would normally cough up stays in your lungs and can become infected.
You can help to prevent a chest infection by doing deep breathing exercises. Your healthcare team will explain about these and encourage you to do them regularly after your operation.
Being in pain can also stop you breathing deeply. Tell your nurse if you are in pain. They will be able to give you some painkillers to help.
Your physiotherapists and nurses will get you up as soon as possible to help you get moving. This will help prevent chest infections. It will also help prevent blood clots.
Blood clots
Blood clots (deep vein thrombosis, DVT) are a possible complication of having surgery because you might not move about as much as usual. Clots can block the normal flow of blood through the body. Let your doctor or nurse know if you have an area in your leg that is swollen, hot, red or sore.
There is a risk that a blood clot can become loose and travel through the bloodstream to the lungs, causing a blockage there (a pulmonary embolism). Symptoms include:
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shortness of breath
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chest pain
-
coughing up blood
-
feeling dizzy or lightheaded
If you have any symptoms of a blood clot when you are at home, see your GP or go to your nearest accident and emergency department (A&E).
To try to prevent blood clots you wear compression stockings after surgery. You also have daily injections for several weeks to thin your blood, and your nurses will encourage you to get up as soon as possible or do regular leg exercises.
Breathing and circulation exercises after surgery
Below is a short video showing breathing and circulation exercises after surgery.
These exercises help prevent you developing a chest infection or blood clots in your legs after surgery. These problems are more likely when you are not moving around as you would normally.
You can do these breathing exercises while sitting up in a chair or in a bed or whilst lying down.
Relax your shoulders and upper chest.
Take a slow, deep, comfortable breath in and hold for a couple of seconds, then slowly breathe out.
Repeat this 3 times.
You can start these breathing exercises as soon as you come round from your anaesthetic.
You should try to do them every hour when awake until you are fully mobile.
If you need to cough, support your wound with your arms, a pillow or a rolled up towel.
If you are struggling to clear any phlegm, try a huff. This is where you breathe out in a short, sharp manner as if you were trying to steam up a mirror.
You should move about as soon as possible after your operation. But while you are not as mobile, try to keep your legs moving to encourage better circulation.
You can do these exercises in a bed or in a chair.
One foot at a time, point your toes away from you then pull your toes towards your chin.
Try to do 10 of these on both feet at least 2-3 times an hour.
The next exercise is circling your ankles. One at a time circle your ankles, clockwise and then anticlockwise. Repeat this 10 times with each ankle 2-3 times an hour.
Bleeding
You may have bleeding after your operation. This can be from your wound or inside your abdomen. Reasons for this include:
- a leak where your surgeon stopped a blood vessel from bleeding during the operation
- your blood is not clotting properly
Treatment depends on how much you are bleeding and what is causing it. Sometimes you may need a to replace some of the blood you have lost. Rarely you will need another operation to stop the bleeding.
Your doctor and nurses will regularly check for signs of bleeding after surgery.
Bile leak
A leak can happen in the area where the bile ducts are stitched back together. Bile can also leak from the cut surface of the liver if you had surgery to remove part of it.
A leak can cause bile to collect in your abdomen. Your doctor usually leaves a drainage tube in until the leak stops.
Bowel stops working properly
Your bowel may be slow to work after your operation. Doctors call this ileus. Symptoms include:
- feeling or being sick
- swollen abdomen
- not passing any wind
You might get ileus a couple of days after your operation.
If you’ve been eating and drinking, your doctor may ask you to stop until your bowel starts working properly again. They give you fluids into your bloodstream whilst you are not eating and drinking. This is to stop you getting dehydrated.
Sometimes you may have a tube down your nose and into your stomach after the operation. This is called a nasogastric tube. Bile drains from your stomach into a bag on the end of the tube. It can stop you from feeling sick. If you don’t have a nasogastric tube after your operation, your doctor may put one in if you have ileus.
Your bowel normally starts working properly after a few days. You will be allowed to slowly start drinking and build up to eating once it’s working.
Problems after surgery to remove intrahepatic or perihilar bile duct cancer
If you have had part of your liver removed you may get other complications. These include:
Liver failure
Some peoples liver may stop working properly after surgery. This is called liver failure. The risk is higher if you have had liver problems before.
Before you have surgery, you have tests to check how well your liver is working and to check for other liver conditions such as cirrhosis.
You will have regular blood tests after the operation to check how well your liver is working.
Build up of fluid in the abdomen (ascites)
You might have a build up of fluid in your tummy (abdomen) called ascites.
This can happen for different reasons, including an increase in pressure in one of the main blood vessels of the liver (portal vein). Your doctor can give you medicines to help reduce the fluid. Sometimes, they may put a tube into your tummy to drain the fluid.
Problems after surgery to remove distal bile duct cancer
If you have part of your pancreas and small bowel removed you may get other complications. These include:
Pancreatic juice leak
The pancreas makes pancreatic juice which helps you digest your food. After the operation some of this juice can leak into the space in your abdomen where your organs are (peritoneal space). This can irritate the lining of the peritoneal space and cause an abnormal opening to form. The opening is called a fistula.
Your doctor usually leaves the drain in your abdomen until the leak stops. You also have antibiotics. Sometimes you might need another operation to stop the leak or repair the fistula.
Delayed gastric emptying
Delayed gastric emptying (DGE) is a common complication after pancreas surgery. It’s more common with people who have had a pylorus preserving pancreaticoduodenectomy (PPPD). It means the stomach takes a long time to empty its contents into the small bowel.
Having DGE means you might feel uncomfortable due to a full stomach. Other symptoms include:
- feeling or being sick
- tummy (abdominal) pain
- feeling bloated
- heartburn or indigestion
- being unable to finish a meal as you feel full sooner
Some of the treatments can involve medicines to help move food through your stomach faster. You may also need painkillers and medicines to help with sickness. And you may need a tube down your nose and into your stomach if you haven’t got one already. This is called a nasogastric tube. It helps remove the contents of your stomach to stop you from being sick.
Other treatments might involve changing what you eat and how often you eat.
Malabsorption
The pancreas makes digestive juice which contains enzymes. These help break down food into very small fragments. The fragments are absorbed into the body through the small bowel.
After pancreatic surgery you might make less digestive juice. This means you can’t break down food as it passes through your digestive system. So, you are not absorbing any nutrients, proteins or vitamins from it. This is called malabsorption.
Symptoms can include:
- weight loss
- pale or yellow poo that smells quite bad
- oily poo that is difficult
- to flush away
- passing more wind than usual
- burping
- loose poo (diarrhoea)
You normally take pancreatic enzyme supplements to replace the enzymes.
Diabetes
Your pancreas makes insulin. This keeps the sugar levels (glucose) in your blood at a stable level. If you don't make enough insulin to keep your blood sugar stable it is called diabetes.
When you have part of your pancreas removed, you will probably still make enough insulin. But your doctor keeps a close eye on your blood sugar to make sure you don't develop diabetes.
