Gallbladder issues after removal: Digestive Problems after Gallbladder Removal
Life after Gallbladder Removal | Everyday Health
However, when you remove the gallbladder, you remove the reservoir, Brugge says. So, even though you will have the same amount of bile in your body, you will not have as much bile in your intestine after your gallbladder is gone.
“The bile is constantly being delivered into your intestine instead of being stored,” Brugge explains. In theory, this means that you will not digest food as well.
“But most animal species in the world don’t have gallbladders,” Brugge says. And your gallbladder is an organ you can live without.
Digestion Changes After Gallbladder Removal
In the first few weeks after your surgery, your doctor probably will recommend that you eat a mostly low-fat diet while your body adjusts to living without a gallbladder. After that, “ninety percent of people go back to eating the way they did before,” says Brugge.
Brugge says that digestive symptoms are relatively uncommon after gallbladder removal. But some people will notice a change in their digestion.
“The most common thing is people have more frequent bowel movements,” Brugge says.
Laura Consolo of Melrose, Mass., had her gallbladder removed 12 years ago and has experienced some digestive changes.
“I probably noticed the change about two months after the surgery,” says Consolo, now in her early forties. “If I ate a lot of fatty foods, I would have a really bad stomachache and need to run to the bathroom,” she continues. “It was pretty much a constant thing for a while.”
Managing Digestive Problems After Gallbladder Removal
Brugge notes that gallbladder removal-related digestive symptoms usually go away over time, but that some people need to take medications or make lifestyle changes to help manage their symptoms. “There are medications [people can] take that will bind the bile,” says Brugge.
Some of the lifestyle changes that can help ease digestive symptoms when you’re living without a gallbladder are:
- Adopt a low-fat diet
- Avoid eating fatty foods, such as fried foods
- Eat small, frequent meals
- Avoid eating a very large dinner after fasting all day
Consolo says that she took medications to manage her symptoms, but eventually wanted to wean herself off these drugs. She is now able to manage her symptoms with a high-fiber, low-fat diet.
The Link Between Gallbladder Problems and Diabetes
A meta-analysis published in March 2016 in the Journal of Diabetes and Its Complications shows mounting evidence for an increased risk of gallbladder disease among people with diabetes. But “we still don’t know why,” says Armand A. Krikorian, MD, an endocrinologist at University Hospitals Case Medical Center and an assistant professor of medicine at Case Western Reserve University School of Medicine in Cleveland.
But there are multiple theories about how diabetes and insulin resistance in general affect gallbladder health. For one, people with type 2 diabetes tend to be overweight or obese, one of the main risk factors of gallbladder disease. Obesity increases cholesterol secretion into the bile, which can accumulate in the gallbladder and eventually lead to the formation of gallstones.
People with diabetes also have higher levels of triglycerides, a type of fat that may encourage gallstone formation, according to the Penn State Health Milton S. Hershey Medical Center.
Another theory is that stones form because of what is called autonomic neuropathy, or damage from diabetes to the involuntary nerves that control movement of the bowels and gallbladder. According to research published in the International Journal of Medical and Dental Sciences, the bile stored in the gallbladder is not released efficiently because the nerves are damaged, and gallstones form from the resulting sludge.
How to Manage Diabetes to Prevent Gallbladder Problems
Dr. Krikorian says that for a person living with diabetes, controlling your condition is the best way to head off gallbladder problems.
Tips for controlling your diabetes include:
- Developing a management plan with your doctor that focuses on diet and exercise
- Taking your medication
- Monitoring your blood sugar levels as directed by your doctor
When diabetes is under control, it’s much less likely that autonomic neuropathy will become an issue and your triglyceride levels should be lower — thus decreasing your odds of developing gallstones, according to Krikorian.
Know the Symptoms of a Gallbladder Problem
Because people with diabetes are at an increased risk of developing gallstones, Krikorian says, it’s important to know the symptoms of common gallbladder problems, such as gallstones.
Symptoms of a gallbladder attack may include:
- Sudden pain in the right upper abdomen that can last several hours
- Pain between the shoulder blades or under the right shoulder
- Abdominal pain centered on the right side that gets worse after eating
- Unexplained nausea or vomiting
Getting Treatment for Gallbladder Problems When You Have Diabetes
People with diabetes are usually considered high risk for any surgery, including gallbladder surgery, says Krikorian. But, in most cases, when gallstones are problematic, the best course of action is to remove the gallbladder. According to Krikorian, controlling the diabetes doesn’t change after the gallbladder is removed.
In general, whether they have diabetes or not, most people can avoid gallbladder problems by eating a consistently balanced diet, getting enough exercise, and managing their overall health.
Additional reporting by Jamie Putman
Chronic diarrhea: A concern after gallbladder removal?
I had my gallbladder removed six months ago, and I’m still having diarrhea. Is this normal?
Answer From Michael F. Picco, M.D.
It’s not clear how many people develop the frequent loose, watery stools that characterize diarrhea after surgery to remove their gallbladders (cholecystectomy). Studies have found that up to 20% of people undergoing gallbladder surgery develop diarrhea.
In most cases, the diarrhea stops soon after the surgery. Rarely, it may last for years.
The cause of diarrhea after gallbladder removal isn’t clear. Some experts believe that it results from an increase in bile, especially bile acids, entering the large intestine — which may act as a laxative.
Treatments you and your doctor may consider for controlling your diarrhea after cholecystectomy include:
- Anti-diarrheal medications, such as loperamide (Imodium A-D)
- Medications that impair absorption of bile acids, such as cholestyramine
Talk to your doctor about your options and whether additional tests are recommended. Generally, mild diarrhea after cholecystectomy is not cause for concern, but speak to you doctor if you are losing weight; have bloody diarrhea, diarrhea that awakens you from sleep, fever or significant abdominal pain; or have diarrhea lasting more than a few weeks.
You may also consider limiting foods that can make diarrhea worse, including:
- Dairy products
- Greasy foods
- Very sweet foods
- Can you recommend a diet after gallbladder removal?
Sept. 29, 2021
- Kim SS, et al. Laparoscopic cholecystectomy. JAMA. 2018; doi:10.1001/jama.2018.3438.
- Feldman M, et al. Diarrhea. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed Nov. 4, 2019.
- Ralston SH, et al., eds. Hepatology. In: Davidson’s Principles and Practice of Medicine. 23rd ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Nov. 4, 2019.
- Jarnigan WR, ed. Postcholecystectomy problems. In: Blumgart’s Surgery of the Liver, Biliary Tract, and Pancreas. 6th ed. Elsevier; 2017. https://www.clinicalkey.com. Accessed Nov. 4, 2019.
- Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea. Accessed Nov. 1, 2019.
- Picco MF (expert opinion). Mayo Clinic. Nov. 14, 2019.
See more Expert Answers
Cholecystectomy | Johns Hopkins Medicine
What is a cholecystectomy?
A cholecystectomy is surgery to remove your gallbladder.
The gallbladder is a small organ under your liver. It is on the upper right side of your belly or abdomen. The gallbladder stores a digestive juice called bile which is made in the liver.
There are 2 types of surgery to remove the gallbladder:
Open (traditional) method. In this method, 1 cut (incision) about 4 to 6 inches long is made in the upper right-hand side of your belly. The surgeon finds the gallbladder and takes it out through the incision.
Laparoscopic method. This method uses 3 to 4 very small incisions. It uses a long, thin tube called a laparoscope. The tube has a tiny video camera and surgical tools. The tube, camera and tools are put in through the incisions. The surgeon does the surgery while looking at a TV monitor. The gallbladder is removed through 1 of the incisions.
A laparoscopic cholecystectomy is less invasive. That means it uses very small incisions in your belly. There is less bleeding. The recovery time is usually shorter than an open surgery.
In some cases the laparoscope may show that your gallbladder is very diseased. Or it may show other problems. Then the surgeon may have to use an open surgery method to remove your gallbladder safely.
Why might I need a cholecystectomy?
A cholecystectomy may be done if your gallbladder:
Gallbladder problems may cause pain which:
Is usually on the right side or middle of your upper belly
May be constant or may get worse after a heavy meal
May sometimes feel more like fullness than pain
May be felt in your back and in the tip of your right shoulder blade
Other symptoms may include nausea, vomiting, fever, and chills.
The symptoms of gallbladder problems may look like other health problems. Always see your healthcare provider to be sure.
Your healthcare provider may have other reasons to recommend a cholecystectomy.
What are the risks of a cholecystectomy?
Some possible complications of a cholecystectomy may include:
Injury to the tube (the bile duct) that carries bile from the gallbladder to the small intestine
Scars and a numb feeling at the incision site
A bulging of organ or tissue (a hernia) at the incision site
During a laparoscopic procedure, surgical tools are put into your belly. This may hurt your intestines or blood vessels.
You may have other risks that are unique to you. Be sure to discuss any concerns with your healthcare provider before the procedure.
How do I get ready for a cholecystectomy?
Your healthcare provider will explain the procedure to you. Ask him or her any questions you have.
You may be asked to sign a consent form that gives permission for the procedure. Read the form carefully and ask questions if anything is not clear.
Your provider will ask questions about your past health. He or she may also give you a physical exam. This is to make sure you are in good health before the procedure. You may also need blood tests and other diagnostic tests.
You must not eat or drink for 8 hours before the procedure. This often means no food or drink after midnight.
Tell your provider if you are pregnant or think you may be pregnant.
Tell your provider if you are sensitive to or allergic to any medicines, latex, tape, and anesthesia medicines (local and general).
Tell your provider about all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.
Tell your provider if you have a history of bleeding disorders. Let your provider know if you are taking any blood-thinning medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.
If this is an outpatient procedure, you will need to have someone drive you home afterward. You won’t be able to drive because of the medicine given to relax you before and during the procedure.
Follow any other instructions your provider gives you to get ready.
What happens during a cholecystectomy?
You may have a cholecystectomy as an outpatient or as part of your stay in a hospital. The way the surgery is done may vary depending on your condition and your healthcare provider’s practices.
A cholecystectomy is generally done while you are given medicines to put you into a deep sleep (under general anesthesia).
Generally, a cholecystectomy follows this process:
You will be asked to take off any jewelry or other objects that might interfere during surgery.
You will be asked to remove clothing and be given a gown to wear.
An intravenous (IV) line will be put in your arm or hand.
You will be placed on your back on the operating table. The anesthesia will be started.
A tube will be put down your throat to help you breathe. The anesthesiologist will check your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
If there is a lot of hair at the surgical site, it may be clipped off.
The skin over the surgical site will be cleaned with a sterile (antiseptic) solution.
Open method cholecystectomy
An incision will be made. The incision may slant under your ribs on the right side of your abdomen. Or it may be made in the upper part of your abdomen.
Your gallbladder is removed.
In some cases, 1 or more drains may be put into the incision. This allows drainage of fluids or pus.
Laparoscopic method cholecystectomy
About 3 or 4 small incisions will be made in your abdomen. Carbon dioxide gas will be put into your abdomen so that it swells up. This lets the gallbladder and nearby organs be easily seen.
The laparoscope will be put into an incision. Surgical tools will be put through the other incisions to remove your gallbladder.
When the surgery is done, the laparoscope and tools are removed. The carbon dioxide gas is let out through the incisions. Most of it will be reabsorbed by your body.
Procedure completion, both methods
The gallbladder will be sent to a lab for testing
The incisions will be closed with stitches or surgical staples
A sterile bandage or dressing or adhesive strips will be used to cover the wounds
What happens after a cholecystectomy?
In the hospital
After the procedure, you will be taken to the recovery room to be watched. Your recovery process will depend on the type of surgery and the type of anesthesia you had. Once your blood pressure, pulse, and breathing are stable and you are awake and alert, you will be taken to your hospital room.
A laparoscopic cholecystectomy may be done on an outpatient basis. In this case, you may be discharged home from the recovery room.
You will get pain medicine as needed. A nurse may give it to you. Or you may give it to yourself through a device connected to your IV (intravenous) line.
You may have a thin plastic tube that goes through your nose into your stomach. This is to remove air that you swallow. The tube will be taken out when your bowels are working normally. You won’t be able to eat or drink until the tube is removed.
You may have 1 or more drains in the incision if an open procedure was done. The drains will be removed in a day or so. You might be discharged with the drain still in and covered with a dressing. Follow your provider’s instructions for taking care of it.
You will be asked to get out of bed a few hours after a laparoscopic procedure or by the next day after an open procedure.
Depending on your situation, you may be given liquids to drink a few hours after surgery. You will slowly be able to eat more solid foods as tolerated.
Arrangements will be made for a follow-up visit with your provider. This is usually 2 to 3 weeks after surgery.
Once you are home, it’s important to keep the incision clean and dry. Your provider will give you specific bathing instructions. If stitches or surgical staples are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and usually will fall off within a few days.
The incision and your abdominal muscles may ache, especially after long periods of standing. If you had a laparoscopic surgery, you may feel pain from any carbon dioxide gas still in your belly. This pain may last for a few days. It should feel a bit better each day.
Take a pain reliever as recommended by your provider. Aspirin or other pain medicines may raise your risk of bleeding. Be sure to take only medicines your healthcare provider has approved.
Walking and limited movement are generally fine. But you should avoid strenuous activity. Your provider will tell you when you can return to work and go back to normal activities.
Call your provider if you have any of the following:
Fever or chills
Redness, swelling, bleeding, or other drainage from the incision site
More pain around the incision site
Yellowing of your skin or the whites of your eyes (jaundice)
Belly or abdominal pain, cramping, or swelling
No bowel movement or gas for 3 days
Pain behind your breastbone
What Diet Should You Follow After Gallbladder Surgery? What to Eat and What to Avoid
Your gallbladder is a small organ located under your liver. It stores bile from the liver to help you digest fats.
If you need to have your gallbladder removed, you will likely have to make changes to your diet after surgery. You’ll want to avoid problems such as gas, bloating, and diarrhea as much as possible.
There is no set diet you should follow after having your gallbladder removed, but there are some guidelines that may help avoid issues.
Quick Tips for Immediately After Your Surgery
For the first few days after your surgery, your diet should be made up of clear liquids, broth, and gelatin. And while some alcoholic beverages may be clear, you should avoid alcohol for at least two days after your surgery.
After the first few days, you can start gradually adding solid food back into your diet. You should stick with small meals at first.
Avoid these types of foods when you start adding foods back into your diet:
Foods to Avoid After You Have Your Gallbladder Removed
You may develop diarrhea after having your gallbladder removed. The reason is that without your gallbladder, bile flows directly into your intestines and acts as a laxative.
The diarrhea caused by that process usually goes away in a few weeks to a few months. For quickest results, try avoiding the following:
High-fat foods. Because high-fat foods are harder to digest, you should avoid them if you’re having gas, bloating, or diarrhea after your surgery. In general, fat should make up no more than 30% of your daily calories. Saturated fat should make up no more than 10% of your daily calories.
Try to stick with foods that contain less than 3 grams of fat per serving. Foods that are high in fat include:
- Bacon fat
- Poultry skin
- Hot dogs
- Whole milk
- Ice cream
- Full-fat cheese
- Tropical oils such as palm and coconut
- Processed baked goods such as cookies, pastries, and cakes
Spicy foods. Foods that contain capsaicin, the active ingredient in hot peppers, can irritate your stomach lining. This can cause stomach pain, nausea, vomiting, and diarrhea.
Foods that generally make diarrhea worse. You may get some relief by avoiding caffeine, dairy products, and very sweet foods.
Foods to Eat After You Have Your Gallbladder Removed
Fluids. Diarrhea can drain your body of vitamins, minerals, and fluids, so it’s crucial to stay hydrated. Drink plenty of water, broth, and sports drinks. But again, avoid alcohol for at least 2 days after your surgery, especially if you’re feeling the effects of anesthesia or pain meds.
Low-fat foods. Low-fat foods will be easier for you to digest and are less likely to cause gas, bloating, or diarrhea. After your surgery, you shouldn’t eat more than 30% of your calories from fat, even if it’s from low-fat foods. Low-fat options include:
- Low-fat, 1%, or fat-free dairy products
- Fat-free cheeses
- Egg whites or egg substitutes
- Veggie burgers
- Beans, peas, lentils
- Whole grains
- Brown rice
- Low-fat crackers and bread
- Soups with a vegetable base
- Sauces made with skim milk
- Light margarine
- Light mayonnaise
- Light salad dressings
High-fiber foods. Foods high in fiber can help normalize your bowel movements. However, you should gradually increase your fiber intake over several weeks, since increasing it too rapidly can make gas and cramping worse. There are two types of fiber, soluble and insoluble. Both should be a part of your diet.
Soluble fiber absorbs water during digestion. It can increase the bulk of your stool and slow down digestion. Examples of foods high in soluble fiber include:
- Black beans
- Lima beans
- Navy beans
- Pinto beans
- Soy burgers
- Oat bran
Insoluble fiber doesn’t dissolve in water. It absorbs fluid and sticks to other materials. This forms softer, bulkier, and more regular stools. Insoluble fiber helps your body process waste better. Good sources of insoluble fiber include:
- Wheat bran
- Wheat germ
- Oat bran
- Berries such as blackberries, blueberries, strawberries
- Green peas
- Green beans
- Whole wheat flour
Tracking What You Eat With a Food Journal
Writing down what you eat, how much, and when can help you see how foods affect you after you have your gallbladder removed. Keeping a log of any negative reactions to food can help you avoid foods that cause problems. Most people will be able to return to a regular diet within a month after surgery.
When to Call Your Doctor
Though diarrhea that persists for several months is common after gallbladder removal, you should still discuss it with your doctor if it persists for more than 3 days after surgery. Additionally, if you have any of the following symptoms, you should talk to your doctor about them:
- Severe nausea or vomiting
- Abdominal pain that doesn’t go away or gets worse
- Inability to pass gas for more than three days after surgery
- Inability to have a bowel movement for more than three days after surgery
Etiologies of Long-Term Postcholecystectomy Symptoms: A Systematic Review
Background. Cholecystectomy does not relieve abdominal symptoms in up to 40% of patients. With 700,000 cholecystectomies performed in the US, annually, about 280,000 patients are left with symptoms, making this a serious problem. We performed a systematic review to determine the different etiologies of long-term postcholecystectomy symptoms with the aim to provide guidance for clinicians treating these patients. Methods. A systematic search of the literature was performed using MEDLINE, EMBASE, and Web of Science. Articles describing at least one possible etiology of long-term symptoms after a laparoscopic cholecystectomy were included in this review. Long-term symptoms were defined as abdominal symptoms that were present at least four weeks after cholecystectomy, either persistent or incident. The etiologies of persistent and incident symptoms after LC and the mechanism or hypothesis behind the etiologies are provided. If available, the prevalence of the discussed etiology is provided. Results. The search strategy identified 3320 articles of which 130 articles were included. Etiologies for persistent symptoms were residual and newly formed gallstones (41 studies, prevalence ranged from 0.2 to 23%), coexistent diseases (64 studies, prevalence 1-65%), and psychological distress (13 studies, no prevalence provided). Etiologies for incident symptoms were surgical complications (21 studies, prevalence 1-3%) and physiological changes (39 studies, prevalence 16-58%). Sphincter of Oddi dysfunction (SOD) was reported as an etiology for both persistent and incident symptoms (21 studies, prevalence 3-40%). Conclusion. Long-term postcholecystectomy symptoms vary amongst patients, arise from different etiologies, and require specific diagnostic and treatment strategies. Most symptoms after cholecystectomy seem to be caused by coexistent diseases and physiological changes due to cholecystectomy. The outcome of this research is summarized in a decision tree to give clinical guidance on the treatment of patients with symptoms after cholecystectomy.
In the United States (US), approximately 1.8 million patients are diagnosed with gallstones every year . In the majority of patients, gallstones will stay asymptomatic. Approximately 20% of patients will experience symptoms, like a biliary colic, for which laparoscopic cholecystectomy (LC) is the preferred treatment [2–4]. As a consequence, LC is one of the most performed elective abdominal surgeries worldwide, with approximately 700,000 LCs in the US .
Although LC is the preferred treatment to relieve symptoms, previous studies show that long-term abdominal symptoms are present in up to 40% of patients after LC [6–9]. This equals a yearly growth of 280,000 cases with abdominal symptoms after LC in the US. Patients suffer from symptoms like diarrhea, gas bloating, nausea, vomiting, jaundice, or abdominal pain. These symptoms after LC are a significant burden to health care systems, as 56% of patients need additional health care for diagnosis and treatment, against direct median hospital costs of $555 per year per patient. Moreover, sick leave and production loss of employed patients add an additional $361 per year per patient for work-related costs .
Abdominal symptoms after LC are often summarized as “postcholecystectomy syndrome.” However, postcholecystectomy syndrome is an arbitrary term that loosely describes the presence of symptoms after LC and consists of many persistent and incident symptoms [11–15]. In order to help patients with abdominal symptoms after LC, a specific diagnosis or etiology of the complaints is needed to provide targeted treatment. Therefore, this systematic review is aimed at providing an overview of the literature on etiologies of abdominal symptoms after LC and ultimately to assist clinicians in identifying the cause of patients’ symptoms after LC and optimize treatment.
The PRISMA guideline (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used to perform this systematic review .
2.1. Search Strategy
A systematic literature search was conducted in the electronic databases of MEDLINE (1946–June 2018), Web of Science (1945–June 2018), and EMBASE (1980–June 2018). The search was performed using a search strategy that included terms for “(postcholecystectomy) abdominal symptoms,” “cholecystectomy,” and “cholecystolithiasis” (the full search strategy is shown in Supplementary Table 1).
2.2. Study Selection
Two reviewers (C.L. and S.W.) independently screened the titles and abstracts of the identified articles to select potentially relevant studies. Studies on abdominal symptoms after LC in uncomplicated cholecystolithiasis years, reporting at least one potential etiology for long-term symptoms, were eligible for inclusion. Long-term symptoms after LC were defined as any type of abdominal symptoms that were present at least four weeks after LC. Case reports, case series, editorials, and studies in a language other than English, Dutch, or German were excluded. Studies including patients after open cholecystectomy were excluded, as this does not reflect current surgical practice . Discrepancies between the reviewers were resolved by discussion and consensus. In case of overlapping data, the most recent study with the largest cohort was included.
2.3. Data Extraction and Synthesis
Data were independently extracted by the two reviewers (C.L. and S.W.), using a predefined data extraction form. All described etiologies for long-term postcholecystectomy symptoms and the prevalence of these etiologies (if provided in the study) were extracted. Further extracted data included the following study characteristics: author, year of publication, country, study design, sample size, and follow-up period, and additional data on patients’ age and gender, and long-term postcholecystectomy symptoms. Again, discrepancies between reviewers were resolved by discussion and consensus.
Subsequently, all etiologies were categorized as etiology for “persistent symptoms” or “incident symptoms” after LC and reported in subgroups per category. Persistent symptoms were defined as symptoms that are similar to patients’ preoperative symptoms. Incident symptoms were defined as symptoms that were not present before LC. Primary outcomes of this review were the etiologies of persistent and incident symptoms after LC; the range in prevalence of each etiology in the included studies was reported.
3.1. Selected Studies
The search strategy identified 3320 articles. After removal of duplicates, titles and abstracts of 2226 articles were screened and 269 articles were selected for full-text evaluation. Finally, 130 articles were included in this review, as shown in Figure 1.
3.2. Study Characteristics
The included studies composed of 77 prospective cohort studies, 24 retrospective cohort studies, 20 reviews, five randomized controlled trials, and four systematic reviews. Most studies were performed in Europe and North America. The postoperative follow-up period in the included studies varied from four weeks to 18 years after LC. Full study characteristics are summarized in Table S2 in the supplementary files.
3.3. Reported Etiologies of Long-Term Symptoms after LC
The reviewed literature reported the following symptoms: biliary pain, pain attacks, continuous pain, pain related to food, functional dyspepsia, nausea, vomiting, abdominal bloating, reflux, diarrhea, constipation, functional bowel problems, fever, and jaundice.
Persistent symptoms after LC were summarized into four subgroups: “residual and newly formed gallstones,” “coexistent diseases,” “psychological distress,” and “sphincter of Oddi dysfunction.” Three subgroups for etiologies of incident symptoms after LC were established: “sphincter of Oddi dysfunction,” “surgical complications,” and “physiological changes” (Figure 2). Sphincter of Oddi dysfunction (SOD) can cause persistent symptoms; however, most often it arises after LC. The etiologies reported per included study and if provided the percentage of patients with a certain etiology as cause for symptoms after LC are summarized in Table S2.
4. Persistent Symptoms
4.1. Residual and Newly Formed Gallstones
Forty-one studies reported residual or newly formed gallstones as the etiology for long-term persistent abdominal symptoms after LC. A total of 23 studies provided the prevalence of residual and newly formed gallstones as the cause for symptoms, ranging from 0.2% to 23%. Residual stones are most commonly diagnosed as retained common bile duct stones (choledocholithiasis), stones, or sludge in a cystic duct remnant or stones within the remnant gallbladder due to a subtotal cholecystectomy in difficult surgical cases. Residual stones in the cystic duct or gallbladder remnant can result in recurrent biliary colics [18–22]. Usually, these symptoms are self-limiting. Choledocholithiasis after LC is associated with epigastric pain, elevated ALT and AST levels, and sometimes jaundice [22–24]. Additional abdominal ultrasound might show a dilated common bile duct . Moreover, new gallstones can be formed within the bile ducts or gallbladder remnants, after LC. Depending on the location in the biliary tract, symptoms will be similar to cystic duct or gallbladder remnant stones, or choledocholithiasis [25, 26].
4.2. Coexistent Diseases
Sixty-four studies reported coexistent diseases as the etiology for long-term persistent abdominal symptoms after LC. Eighteen studies provided the prevalence of coexistent diseases after LC ranging from 1% to 65%. Coexistent diseases in patients with gallstones are common and mainly nonbiliary: gastroesophageal reflux, peptic ulcer, hiatus hernia, gastritis, constipation, IBS, Anterior Cutaneous Nerve Entrapment Syndrome (ACNES), fatty liver disease, chronic obstructive pulmonary disease, or coronary artery disease [27, 28]. Preoperative distinction between symptoms caused by coexistent diseases and gallstones is challenging [29–32]. Misinterpretation of symptoms and suboptimal indication for LC will result in persistent symptoms after surgery [8, 9, 27, 30–36]. Even if the indication for LC was made correctly and the biliary symptoms are resolved, symptoms of a coexistent disease can become more prominent and considered as persistent symptoms after LC [29, 37].
4.3. Psychological Distress
Thirteen studies reported psychological distress as the etiology for long-term persistent abdominal symptoms after LC. None of these studies provided prevalence for psychological distress as cause for symptoms after LC. Several hypotheses exist on why psychologically distressed patients are more likely to experience persistent symptoms after LC. First, psychologically distressed patients tend to experience more functional gastrointestinal symptoms, which are not relieved by LC [38–40]. Secondly, psychological distress may induce visceral hyperalgesia that exacerbates subjective perception of pain both preoperatively and postoperatively . Third, these patients are prone to experience somatization symptoms which may cause overreporting of symptoms . Somatization symptoms are also less likely to be alleviated by surgery [39, 43]. Considering the different perceptions and interpretations, patients with psychological distress are more at risk for poor decision-making [38–40].
4.4. Sphincter of Oddi Dysfunction
Seventeen studies reported sphincter of Oddi dysfunction (SOD) as the etiology for long-term abdominal symptoms after LC. Prevalence of SOD after LC was reported in four studies and ranged from 3% to 40%. SOD mainly presents as right upper quadrant (biliary) pain and is not easily distinguished from symptomatic cholecystolithiasis, irritable bowel syndrome, or functional dyspepsia . If SOD symptoms have been incorrectly attributed to gallstones, symptoms will persist after LC [15, 45, 46]. However, SOD most often commences after LC as incident symptoms, in which case interrupted neural pathways between the duodenum, gallbladder, and sphincter of Oddi after surgery lead to sphincter of Oddi spasms or SOD [47–50]. SOD can be divided in three types: type I (biliary pain, abnormal liver tests, and dilated bile duct), type II (biliary pain and abnormal liver tests or dilated bile duct), and type III (only biliary pain) [51, 52].
5. Incident Symptoms
5.1. Surgical Complications
Twenty-one studies reported surgical complications as the etiology for long-term symptoms after LC. Prevalence of long-term symptoms after LC caused by surgical complications was reported in eight studies, ranging from 1% to 3%. Bile duct injury is the most feared surgical complication [53, 54]. Patients can develop upper abdominal pain with jaundice, fever, and possibly sepsis . Even if the bile duct injury is treated with surgical or endoscopic intervention, strictures or leakages can result in long-term symptoms of pain and biliary obstruction [15, 53, 55].
Spillage of gallstones into the peritoneal cavity is another complication associated with long-term postoperative pain, which can lead to abscesses, general peritonitis, adhesions, and fistulae, even several years after surgery [56–59]. However, the majority of dropped gallstones remain clinically silent .
Pain or discomfort due to late postoperative complications can arise from infections, wound healing problems, or a trocar site hernia [40, 60–67].
5.2. Physiological Changes
Thirty-nine studies reported physiological changes after surgery as the etiology for incident abdominal symptoms after LC. The prevalence of physiological changes after LC was described in 17 studies, ranging from 16% to 58%. Long-term effects of LC on bile acid metabolism were reported in several studies [61, 68–70]. Prior to LC, bile acids are stored in the gallbladder and bile acids are released in the duodenum by meal-induced intermittent contractions. LC results in the loss of reservoir function of the gallbladder and an altered bile metabolism. The pathophysiology of increased bile flow has not been completely clarified. However, the continuous flow of bile acids into the duodenum attributes to increased duodenal-gastric reflux and can cause symptoms of dyspepsia and an elevated risk of gastritis [49, 71–73]. Decreased esophageal sphincter pressure after LC may further attribute to dyspepsia and gastritis symptoms [61, 66, 74].
The reduced bile salt pool after LC could also induce subclinical fat malabsorption and result in diarrhea. The constant presence of bile acids in the gut, which promotes secretion and motility, could additionally result in a shortened whole gut transit time, contributing to postoperative diarrhea and flatulence [49, 68, 69].
Fifteen studies reported various other etiologies for incident long-term abdominal symptoms after LC. Changed dietary intake, mainly waiving preoperative dietary restrictions, or physical inactivity may attribute to symptoms after LC [61, 75].
This systematic review provides a qualitative overview of etiologies of long-term abdominal symptoms after LC. Most symptoms after LC seem to be caused by coexistent diseases and physiological changes due to LC. Based on the etiologies of persistent and incident symptoms after LC provided in this review, we constructed a decision tree to help clinicians identify the cause of long-term symptoms after LC and optimize treatment for these patients (Figure 3).
“Postcholecystectomy syndrome” is a collective term for all symptoms after LC. This general term is not an adequate diagnosis [76–78], as multiple etiologies requiring distinct treatments may cause “postcholecystectomy syndrome.” Moreover, some symptoms are not even related to LC itself. To establish the cause of long-term symptoms after LC and decide on the proper treatment to alleviate symptoms, the underlying etiology of symptoms should be pursued.
Previous reviews divided all causes for symptoms after LC into organ systems  (e.g., biliary causes, pancreatic causes, other gastrointestinal disorders, or extraintestinal disorders) or listed all diagnoses individually (e.g., peptic ulcer disease, hiatus hernia, gastroesophageal reflux, residual stones, strictures, and SOD) . The latter is a review with a limited search reach and only 21 included articles . In this review, we categorized long-term postoperative symptoms as persistent or incident symptoms after LC, thereby providing a first step in deducting the causes for long-term symptoms. If the persistent or incident nature of the symptoms is established, the categories and subgroups presented in this review are a tool for clinicians in the assessment of long-term postcholecystectomy symptoms (Figure 3).
We established that most persisting symptoms are likely to be caused by coexisting diseases; often, these will be nonbiliary symptoms. Detailed anamnesis and tailored diagnostic tests (such as ultrasound, gastroscopy, and colonoscopy) will provide insight in the presence of (functional) abdominal disorders. Accessible therapeutic options should confirm or rule out the diagnosis, for instance, with a test treatment with antacids or laxatives [26, 32, 35, 36, 79].
Persisting biliary pain will mainly be caused by newly formed or residual stones or SOD. These conditions can be diagnosed using abdominal or endoscopic ultrasound. Gallstones will most often be present in the CBD and can be treated by ERCP with papillotomy and stone extraction. SOD type I and II can be distinguished from other disorders by laboratory results, imaging of the biliary tree, and elevated sphincter pressure at manometry. SOD type III is difficult to distinguish from other gastrointestinal disorders, as the only criterion is biliary pain. Some literature recommends endoscopic sphincterotomy to treat SOD [15, 45]; however, recently published long-term results of the EPISOD study show that in type III SOD, endoscopic sphincterotomy was not more successful compared to sham intervention in patients with postcholecystectomy SOD type III [80, 81]. Another study recommends medical treatment, trimebutine, and nitrates taken sublingually, as success rates are similar with endoscopic sphincterotomy .
Newly formed symptoms will often start shortly after LC but can persist and become a long-term problem. Patients with surgical complications should therefore be monitored at the outpatient clinic to obviate persisting symptoms, and surgical, endoscopic, or medical treatment can be started timely (e.g., surgical or endoscopic intervention with a stent or dilatation for bile duct injury or antibiotics for (intra-abdominal) infections). Most incident symptoms will however be physiological. Patients with new reflux symptoms after LC (due to physiological changes in bile secretion and metabolism) can be pragmatically treated with lifestyle changes, drugs that reduce the secretion of gastric acids, prokinetic drugs, or drugs that reduce the relaxations of the esophageal sphincter, to reduce reflux and relieve symptoms. Patients with (invalidating) chronic diarrhea can be treated with a bile acid sequestrant like cholestyramine, colestipol, or colesevelam .
Although this study provides tools to establish and treat symptoms, of course, preventing postoperative symptoms is preferable. A prospective study showed that 56% of patients need additional health care and medical costs and costs for sick leave were approximately $916 per year per patients . Improved patient selection and preoperative work-up for a LC could prevent persistent abdominal symptoms and costs.
In patients with nonspecific gallstone symptoms, the preoperative diagnostic trajectory should focus on confirming or ruling out other causes of upper abdominal symptoms and considering alternative or concomitant therapeutic options. Our research group is currently performing a multicenter prospective study (Dutch Trial Register: NTR7307) to identify the prevalence of functional gastrointestinal disorders (FGID) in patients with gallstones. Current literature suggests prevalence of up to 60% [26, 39, 84, 85]. If such high prevalence is accurate, a large part of persistent symptoms after LC could be explained by coexistent FGID and treatment to prevent persistent symptoms could be initiated prior to surgery. A second prospective study (NTR7267) focuses on establishing the abdominal symptoms for appropriate indication of LC to prevent persistent symptoms caused by wrong surgical indication.
Additionally, shared decision-making and increased influence in choosing their preferred treatment may result in improved physical outcomes and less distress. This is illustrated for psychologically distressed patients  but may very well apply for other patients. Furthermore, we should consider that symptoms before and after LC may be present as part of the metabolic syndrome [86–88]. The metabolic syndrome is described as the underlying disorder for gallstones by abnormalities of insulin resistance, resulting in increased biliary cholesterol synthesis and gallstone formation . LC is aimed at treating the gallstone symptoms, but the lifestyle and other comorbidities associated with the metabolic problem remain untreated. Incorporation of lifestyle changes and treatment of other aspects of the metabolic syndrome could reduce postoperative symptoms in this patient category.
The present review comes with strengths and limitations. Strengthening our study are the broad search and wide inclusion criteria to identify all possible etiologies of long-term abdominal symptoms after LC. Articles on open cholecystectomy were excluded, to prevent bias by etiologies or prevalence (such as higher surgical complications) inherent to the open aspects of the surgery, not reflecting current surgical practice. Additionally, differentiation between incident and persistent symptoms and descriptions of subgroups of etiologies were made to improve clinical applicability of the results. Ultimately, a clinical guidance was provided for physicians in the diagnostics and treatments of patients with symptoms after LC.
Limitations include the large heterogeneity of the included studies and subsequent inability to perform a quality assessment. As only a limited number of included studies reported the prevalence of described etiologies, we could not provide a meta-analysis. Subsequently, we were only able to provide the range of prevalence of the different etiologies to illustrate which etiologies are more and less common.
Postcholecystectomy symptoms have multiple etiologies and can be divided into persistent and incident symptoms. Most symptoms seem to be caused by coexistent diseases and physiological changes due to LC. Although treatment is available for most causes of persistent symptoms after gallbladder removal, optimized indication for surgery remains key.
Conflicts of Interest
The authors declare that there is no conflict of interest regarding the publication of this paper.
Latenstein and Wennmacker substantially contributed to the conception and design; contributed to the acquisition, analysis, and interpretation of the data; drafted the manuscript; finally approved the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. de Reuver, Drenth, van Laarhoven, and de Jong interpreted the data, revised the manuscript critically for important intellectual content, finally approved the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Table S1: search strategy. Table S2: study characteristics of included studies. (Supplementary Materials)
Can you recommend a diet after gallbladder removal?
After having their gallbladder removed (cholecystectomy), some people develop frequent loose, watery stools. In most cases, the diarrhea lasts no more than a few weeks to a few months. There isn’t a specific gallbladder removal diet that you should follow if you have this problem, but there are a few things you might consider.
First, it helps to understand why you’re having diarrhea. Diarrhea after gallbladder removal seems to be related to the release of bile directly into the intestines. Normally, the gallbladder collects and concentrates bile, releasing it when you eat to aid the digestion of fat. When the gallbladder is removed, bile is less concentrated and drains more continuously into the intestines, where it can have a laxative effect.
The amount of fat you eat at one time also plays a role. Smaller amounts of fat are easier to digest, while larger amounts can remain undigested and cause gas, bloating and diarrhea.
Although there isn’t a set gallbladder removal diet, the following tips may help minimize problems with diarrhea after you’ve had your gallbladder out:
- Go easy on the fat. Avoid high-fat foods, fried and greasy foods, and fatty sauces and gravies for at least a week after surgery. Instead, choose fat-free or low-fat foods. Low-fat foods are those with no more than 3 grams of fat a serving. Check labels and follow the serving size listed.
- Increase the fiber in your diet. This can help normalize bowel movements. Add soluble fiber, such as oats and barley, to your diet. But be sure to increase the amount of fiber slowly, such as over several weeks, because too much fiber at first can make gas and cramping worse.
- Eat smaller, more-frequent meals. This may ensure a better mix with available bile. A healthy meal should include small amounts of lean protein, such as poultry, fish or fat-free dairy, along with vegetables, fruits and whole grains.
You may also try limiting foods that tend to worsen diarrhea, including:
- Dairy products
- Very sweet foods
Talk with your doctor if your diarrhea doesn’t gradually go away or becomes more severe, or if you lose weight and become weak. Your doctor may recommend medicines, such as loperamide (Imodium A-D), which slows down intestinal movement, or medications that decrease the laxative effect of bile, such as cholestyramine (Prevalite). Your doctor may also suggest that you take a multivitamin to compensate for malabsorption of fat-soluble vitamins.
Last Updated: May 26th, 2021
Nutrition after removal of the gallbladder
Discharge from the surgical department after removal of the gallbladder (cholecystectomy) behind. At home, already in a relaxed atmosphere, you can see the recommendations of the attending physician.
And what is written there in the first place? “COMPLIANCE WITH DIET AND DIET REGIME”
Within a few months after cholecystectomy, the body needs to get used to working differently, because now:
- Bile is continuously secreted into the intestines;
- It is less concentrated and is not able to fully “digest” fats.
Therefore, the 3 main “whales” of nutrition for people without a gallbladder look like this:
- Fractional food intake, starting from 7-8 times a day, gradually reducing to 5-6, in small portions;
- Avoid stomach fullness;
- FORBIDDEN: Spicy, sour, spicy, high fat, canned, fried and sweet foods. NEEDED: Gradually increase your fiber intake (fruits, vegetables, some cereals).
- MEAT – fried steaks, sausages, bacon, beef, bacon, salami, lard;
- DAIRY PRODUCTS – fatty yoghurts, fatty cheeses, fatty sour cream, heavy cream and creams based on them, ice cream;
- DRINKS – strong coffee, tea, energy drinks;
- CONFECTIONERY: cakes, rolls, tarts, biscuits, fresh white bread.
So what is there then? Keep a healthy and tasty list:
- CEREALS, etc.: beans, lentils, barley, oatmeal, potatoes, sprouted and raw seeds, rice, pasta;
- VEGETABLES and FRUITS: cauliflower, Brussels sprouts, broccoli, tomato, avocado, blueberries, blackberries, raspberries;
- MEAT and FISH: chicken, turkey, salmon, trout, herring, cod, halibut;
- NUTS: almonds, cashews, walnuts;
- OIL for cooking: avocado, olive, coconut.
If you are intolerant to some of the foods on the permitted list, try to limit their consumption.
Two sores under one knife
“I had a very big problem: doctors found stones in the gallbladder,
and the gynecologist says that it is urgent to remove the fibroids. It turns out that I need to do two operations in a row. I asked, is it possible to do one operation and remove everything at once? And they tell me that it is impossible. Is it true? Is modern medicine
has nothing to offer people with the same problems as mine? I really don’t want to go under the knife twice.Any advice? “
(Anna Sergeevna K., Moscow)
To our reader’s question, we asked the head of the gynecological department to answer
Center for Endosurgery and Lithotripsy Dmitry ZAPOROZHTSEV.
– Dmitry, I think many Muscovites face similar problems.
Why do surgeons refuse such operations? After all, it would be logical to assume
that it is better to do everything in one go than to operate the person twice.
– I want to say right away that in medicine this is called combined operations. Earlier,
when there was no endoscopic surgery, combined operations were also performed. If
there are two sores, for example, uterine fibroids and gallstones, in this situation,
you definitely need to delete them at the same time. And this is easier than doing two operations. Yes
and for the patient it is better, because everything happens, as they say in surgery, in one
anesthesia; and the patient experiences postoperative recovery once, not twice;
accordingly, the risk of getting a postoperative complication is in the only
number, not plural.
Technically, such a cavity operation is feasible. And the surgeons did it.
However, this has not come into practice, and here’s why. Imagine what it will be like
incision as a result of such an operation. If, for example, we are talking about fibroids and
gallbladder, then the patient will have to be cut from the middle of the hypochondrium to
pubis, that is, through the entire abdomen. It is very difficult to operate both the kidneys and
a small pelvis – a big injury is also obtained.
Therefore, if I were offered abdominal combined operation, to be honest, I would refuse.This is a very big risk.
– But now we have endoscopic surgery. I hope this has changed the situation?
– Quite right. So now is the time to return to combined operations. Thanks to
the endoscope has become much easier. But first, for the uninitiated, I want to explain what it is
such. This device can be thought of as a thin tube or stick – whoever likes it best.
But this is only outwardly.In fact, this is a very complex device. At the end of it is attached a special
a camera that transmits an image to a monitor. The endoscope is inserted into a person through
small punctures in the body. That is, there is no incision, nor, of course, blood. We
we introduce the camera into the navel area and thanks to it we can look at the whole belly from the inside.
And everything will immediately become clear at a glance: what problems the patient has.
We can navigate and plan the least traumatic
operation, even if you have to operate several
diseases.Make a puncture and remove the gallbladder full of stones. Do
two more punctures and remove the cyst in the kidney, and so on. That
there is almost any disease can be operated on.
– By the way, with the help of this method, apparently, it is possible to detect those diseases
which the patient did not even know about.
– This is most often the case. We have just operated on a woman with acute appendicitis.
And when they went inside with an endoscope and looked around, they found a cyst, which
would have to be removed afterwards.And since they found her, so why
would not be removed immediately? We removed it.
– But for this, you probably needed a general surgeon? The appendix is his subject of work.
– It’s very good that we started talking about this. The fact is that not every medical
institution can do a combined operation. Somewhere there are good
endoscopists-surgeons, but no endoscopists-gynecologists. Ideally, in each
the hospital should have teams of operating gynecologists, urologists, and surgeons…
But they are not everywhere yet. By the way, this is exactly what is
the achievement of our Center: we have all the specialists who know the endoscopic method.
Imagine how easy it is to work. I recently operated on a woman who
they also found a tumor of the intestine. We called a surgeon. He’s just
went down one floor and immediately stood at the table. He dealt with
tumor, and then I removed the appendages. And no problem. By the way,
patients who have undergone one, that two or three operations practically do not notice this.
– Dmitry, what problems can be solved using combined operations? In what
cases are they usually done?
– If the hospital has all the specialists who know the endoscopic
surgery, then at the same time you can operate on many sores: cysts
ovary and kidney (by the way, this is quite common in patients), fibroids,
gallbladder with gallstone disease, inguinal hernia and
gynecological, infertility (I mean endometriosis) in combination with hernias and so on…
– To do a combined operation or get rid of diseases in stages,
Of course, it is not only the doctor who decides, but the patient himself. Moreover,
both ways have a right to exist. And there are times when you need to
to do only a combined operation, and, in this regard, it may be
do you even have to persuade the patient?
Of course there are. If a woman has an abdominal problem at the same time,
for example, an ovarian cyst, and on her legs she has thrombophlebitis, which
it is also necessary to operate – in this case it is best
to do exactly the combined operation.The fact is that due to operations
there is a risk of a blood clot in the varicose veins. Moreover,
he can come off and go “for a walk” through the vessels. Then maybe
thromboembolic complications occur. It doesn’t happen often, but it happens.
And if the patient has thrombophlebitis, then the risk of such a complication increases.
In such cases, it is preferable to first “remove the veins”, clogged
blood clots, and then you can immediately proceed to the operation on the abdominal
cavity. And then there is no need to be afraid of complications.
– What are the advantages of combined operations?
– They are cost effective. What is important in our difficult times. After all, one operation –
this is one anesthesia, this is one bed, and so on. Moreover, such
operations that are most sparing for the patient’s health: the time of the operation and, accordingly,
anesthesia is reduced. Before and after the operation, a person spends much less time in
hospital. After all, if, after an abdominal operation, the patient is forced to lie about
12 days, then after the endoscopic in the evening the person gets up,
can walk, take care of himself, and on the third or fourth day he is already discharged.
In addition, after abdominal operations, there is a high risk of purulent complications, often
seams diverge, especially with a large cut. After endoscopic
there is no longer such a high risk of combined operations.
There are other benefits as well. For example, sometimes with chronic
inflammation of the gallbladder, plus a clogged gallbladder, often
there are exacerbations after the first operation. If all problems are removed
right away, this practically does not happen.
– Dmitry, I think women will be interested to know what they will have left
on the body after endoscopic surgery?
– Most importantly, there will be no huge ugly cut in the abdomen.
Even if you have to operate on several organs. During endoscopic operations, do not
scary how many holes to make: three or five. It doesn’t matter much
has as they will overgrow. At first, they will look like small moles.And after a year they will turn so pale that they will become completely invisible. Some
there is not even a trace of the sick. You can easily walk on the beach in the open
swimsuit. After an abdominal operation, women cannot afford such a thing …
P.S. Additional consultation with Dr. Dmitry ZAPOROZHTSEV
about combined operations and other gynecological
problems can be obtained by phone. 305-41-51
Diet after removal of the gallbladder
Removal of the gallbladder (cholecystectomy) is one of the most common operations in the world.However, not all patients who have gone through it forget about their problems. In 40-50% of patients, the so-called postcholecystectomy syndrome develops. The main reason for this condition is a dysfunction of the muscle valve (sphincter of Oddi), which regulates the flow of bile into the duodenum. Chaotic flow of bile and a change in its composition lead to impaired absorption and digestion of fats, inflammation of the duodenum and the development of bile reflux into the stomach. Such changes cause complaints of pain in the right hypochondrium, nausea, bitterness in the mouth, diarrhea.If such symptoms do not undergo strict adherence to dietary recommendations, then you should consult a doctor. The doctor will exclude the surgical reasons for the appearance of complaints, depending on the complaints, he will select the appropriate treatment aimed at normalizing the function of digestion or relieving inflammation in the stomach and duodenum.
Nutrition after removal of the gallbladder
There are general rules of nutrition after surgery, which should be adhered to for about a year.
- Meals every 4 hours. This contributes to an even load on the digestive organs throughout the day and prevents the flow of bile into the stomach. Indeed, before the operation, the bladder played the role of a sac in which bile accumulated between meals, and after it, bile constantly enters the intestines.
- Distribute fat evenly across all meals for better absorption
- Eating a sufficient amount of dietary fiber (bran bread instead of rolls, dried fruits, fruits), which helps to improve the outflow of bile and normalize the intestinal microflora.
- Limit foods that contribute to spasm of the sphincter of Oddi (cold food, strong coffee)
- Instead of roasting, use cooking, baking in the oven.
- Limit the consumption of foods high in fat (20-30 g): pork, many types of sausages, chocolate, cakes, glazed curds, mayonnaise. It should be remembered that the daily fat requirement is approximately 1.1 g-kg of ideal body weight, of which 30% must be provided by vegetable fats.Second courses are prepared from lean beef or chicken or fish.
- For breakfast and dinner, fermented milk products and dishes made from cottage cheese are good – casseroles, puddings, cottage cheese, seasoned with low-fat sour cream. You can cook omelets, boil soft-boiled eggs (but not steep).
- The diet of a person with a removed gallbladder should contain cereals (buckwheat, oatmeal, rice, pearl barley), as well as vegetables and sweet fruits (sour berries and fruits are excluded).Carrots and pumpkin are well suited, which you can cook on your own or add to cereals. For dessert, you can eat a small amount of jam, jam, marshmallow, marmalade or honey.
- It is also worth paying attention to the energy value of the diet. An increase in its energy value, as well as an excess of fats and flour dishes, a lack of dietary fiber can lead to the formation of stones in the bile ducts. The appearance of stones leads to the appearance of persistent pain, is poorly diagnosed and requires a second operation.
Make an appointment for an examination and a consultation with a gastroenterologist at the Grandmedica Medical Clinic.
Removal of the gallbladder – Euromed clinic
One of the most common operations in the field of general surgery is endoscopic cholecystectomy (removal of the gallbladder). The surgeon, the head of the surgical department of the EuroMed Clinic, Andrei Vladimirovich Pinchuk, tells us about the danger of gallstone disease and explains why almost the only way of treatment is surgical.
The diagnosis of “gallstone disease (JLD)” is usually made when the ultrasound revealed the presence of stones (calculi) in the gallbladder and / or bile ducts. Often, gallstones are complicated by acute calculous cholecystitis – an acute inflammation of the gallbladder. In the presence of small stones, obstructive jaundice may appear due to blockage of the biliary tract.
The gallbladder – is a reservoir in which bile produced by the liver accumulates, where it becomes more viscous and concentrated, which contributes to more efficient digestion.When food enters the duodenum from the stomach, special hormones are released, which are a signal to the pancreas that it is time for the secretion of digestive juice, and the gall bladder – that it is time to contract. And with this reduction, the accumulated bile (released around the clock), having reached the desired consistency, through the sphincter of Oddi that has opened due to the aforementioned hormones, is released into the duodenum. The juice secreted by the pancreas also gets there, after which the sphincter of Oddi closes again, and the digestive process begins.Bile is needed in order to emulsify fats, that is, to break large droplets into small ones that can be processed by pancreatic enzymes.
With gallstones, symptoms depend on the form of the disease and can be asymptomatic or cause acute biliary colic.
In the presence of stones in the gallbladder, the latter is ineffectively contracted and, accordingly, ceases to cope with its function of accumulation and release of bile. In addition, if the stones are small, the next contraction of the gallbladder (during digestion, during stress, even simply due to a sudden movement) can cause the stone to shift into the bile duct, which causes biliary colic.The danger of biliary colic lies not only in a sudden sharp pain, but also in the fact that because of it, bile ceases to be secreted, which leads to acute cholecystitis, with the subsequent development of complications (biliary peritonitis, obstructive jaundice), and this can even provoke fatal Exodus.
There is a widespread misconception that if you are not bothered by pain with gallstone disease, then you can do nothing. This is fundamentally wrong! If stones are found in the gallbladder, it means that it no longer fulfills its function, that is, leaving it from this point of view is meaningless.But he is practically a time bomb – an attack can happen at any time and lead to a life-threatening condition.
In a calm state, until the pain begins, the operation will be much easier, faster, the risk of postoperative complications is minimized. If the disease is neglected, the risk of complications both during the operation and after it increases significantly. The pancreas suffers, the function of bile secretion, the risk of developing obstructive jaundice is high, the work of natural sphincters is disrupted, the risk of stones formation in the biliary tract increases, etc.
The National Guidelines for Abdominal Surgery states the following: “Cholelithiasis and acute cholecystitis are potentially life-threatening diseases. Since doctors cannot yet accurately predict the nature of the course of the disease and the likelihood of developing life-threatening complications, removal of the gallbladder is currently the preferred method of treating cholelithiasis and acute cholecystitis. Timely surgical intervention leads to recovery, allows to fully restore the patient’s working capacity and significantly improves the quality of life. “
Before the operation, the doctor prescribes a standard list of examinations: blood and urine tests, ECG, fibrogastroscopy, fluorography. Patients over 40 years of age still need to obtain a therapist’s opinion.
The intervention is performed under anesthesia under the control of a video camera. 4 small incisions (0.5-1 cm) are made on the abdomen through which a laparoscope is inserted into the abdominal cavity. The duration of the operation depends on the state of the gallbladder – with an uncomplicated course of the disease, it is 20-30 minutes.
After the intervention, the patient remains in the hospital for two days under the supervision of a doctor ; a sick leave is issued for 10-12 days.
In the first month after surgery, it is recommended to limit physical activity and follow a diet low in fat, cholesterol-rich foods, and spices. A fractional diet should be maintained.
Later, if the patient feels well, he calmly returns to his usual way of life.
In conclusion, I would like to emphasize once again: if you have stones in the gallbladder, do not delay the visit to the doctor! The sooner you start solving this problem, the more favorable the prognosis of treatment.
Time to remove stones | Press releases on RBK + Tatarstan
The gallbladder is not considered a vital organ, but if stones are found in it, then it becomes a threat to both health and life. It is necessary to take care of getting rid of this problem as soon as possible, without waiting for hepatic colic or other complications, advises the deputy chief physician for surgery of the CMT clinics, Ph.D. Sergey Basos.
– Sergey Fedorovich, removal of the gallbladder (cholicetectomy) is considered the most common operation in the world.Why does it have to be removed so often?
– Because, unfortunately, there is no other way to save a person from cholelithiasis (GSD) and its very dangerous complications.
– How is gallstone disease manifested?
– Dyspeptic symptoms may indicate the formation of stones in the gallbladder – nausea, belching, heartburn, provoked by impaired digestion of food in the gastrointestinal tract, bile entering the stomach and esophagus.Often, gallstones is manifested by aching pains in the right hypochondrium 30-40 minutes after eating. The severity of these pains can be different – from an unpleasant feeling of heaviness to a pronounced pain syndrome with irradiation to the right shoulder girdle under the right shoulder blade, which leads to disruption of human activity and requires medical intervention. Moreover, sometimes pain is easily relieved by the appointment of antispasmodics and a state of rest, and sometimes lead to hospitalization. Hepatic colic is a very dangerous manifestation of the disease, in some cases it ends with the development of acute cholecystitis associated with the wedging of a gallbladder stone and the onset of an infectious process.In this case, emergency surgery is performed.
In the photo: Basos S.F. and Sheiko S.B., Laparoscopic cholecystectomy, “Surgical complex SMT” pr. Rimsky-Korsakov, 87
– And if stones in the gallbladder have become a so-called accidental finding on ultrasound, is it worth doing an operation?
– There is such a form of the disease – asymptomatic cholecystolithiasis.With her, there are stones in the gallbladder, but there are no clinical manifestations of the disease: for the time being, the human condition is not overshadowed by anything. But the presence of stones in the gallbladder in this complex anatomical and functional area sooner or later leads to dysfunctions of the surrounding organs. It can provoke the formation of ulcers of the duodenum and stomach, maintain chronic gastritis, and can lead to the gradual formation of chronic pancreatitis. And if a person carries stones in himself for a long time, the risk of developing diabetes mellitus increases by an order of magnitude.The likelihood of gallbladder cancer is not excluded.
– Can a person treat gastritis provoked by gallstone disease all his life without finding the true cause?
– EGD and abdominal ultrasound put everything in its place almost without a doubt. These studies are required when pain occurs in the right hypochondrium.
– What is the relationship between pancreatitis, diabetes mellitus and gallstone disease?
– The organs located in the abdominal cavity are closely interconnected.The fact is that the common bile duct, into which the gallbladder duct opens, goes directly from the liver to the duodenum, in the same place it goes into the duodenum and pancreatic duct. The presence of pain symptoms leads to discoordination of the sphincter to spasm, and spasm – to an increase in pressure in the ducts, damage to pancreatic cells, scar tissue appears, which eventually leads to a decrease in the number of cells that produce enzymes for digesting food, as well as cells that produce hormones – insulin responsible for carbohydrate metabolism.Thus, chronic pancreatitis and diabetes mellitus are often caused by the gastrointestinal tract.
In the photo: Basos S.F. and Sheiko S.B., Choledocholithotomy choledocholithotomy by laparotomy access, “Surgical complex SMT” pr. Rimsky-Korsakov, 87
– Can this condition be confused with osteochondrosis: a person has gallstone disease, and he is diagnosed with osteochondrosis with intercostal neuralgia?
– More often, with such symptoms, they still first of all think about gallstone disease than about neuralgia.But sometimes, indeed, the clinic of gallstone disease can be simulated by a banal intercostal neuralgia at the level of 5-6-7 ribs. The pain radiates along the intercostal spaces and is localized in the right hypochondrium, which can be mistakenly interpreted as an exacerbation of gallstone disease. Palpation of the intercostal spaces allows you to find a pain point and confidently conclude that the cause of the pain syndrome in this case is neuralgia.
– Who is at high risk of gallstones? What provokes this process?
– Women most often suffer – 6-8 times more often than men.This is due to both the physiology of the female body and pregnancy, the metabolism changes, and in later stages, when the uterus increases in size and pushes the internal organs, the emptying of the gallbladder worsens and conditions are created in it for the crystallization of cholesterol and the formation of stones.
There are other predisposing factors that are characteristic of both men and women. This is heredity, features of metabolism or the structure of the biliary tract, in which conditions arise for incomplete emptying of the gallbladder and the formation of crystals of bile acids and cholesterol with the formation of gallstones.In addition, obesity is recognized as a risk factor for the development of gallstone disease.
– Does this mean that reducing fatty and high-calorie foods in the diet can prevent the formation of gallstones?
– The formation of stones is facilitated by a biochemical violation of the ratio of fatty acids and lecithin, which is in the composition of bile. Perhaps this violation occurs due to an excess of fatty foods. But it is impossible to completely abandon fats, because they cause an increased contraction of the gallbladder and its emptying, preventing the phenomenon of stagnation.
Prevention of cholelithiasis is a healthy, active lifestyle, and a diet with a predominance of foods containing plant fiber. Fatty foods are still in limited quantities.
In the photo: Sergey Fedorovich Basos, surgeon of the highest category, candidate of medical sciences, head.surgery “Clinic CMT”
– Patients try to cure gallstones with therapeutic methods, for example, drugs to dissolve stones.
– Gastroenterologists conduct an examination and, according to indications, prescribe a diet restricting spicy, fatty, fried foods, stone-dissolving therapy, the use of antispasmodic drugs to reduce stagnation in the biliary tract. But this treatment is very rarely effective.In order for the stones to dissolve with such treatment, they must be single, small in size, and the gallbladder must have a good contractile function. If the gallbladder does not contract, then the effect of litholytic (stone-dissolving) drugs is ineffective.
– What research needs to be done to understand whether drug therapy will help or should you go straight to the surgeon?
– To find out whether stone-dissolving therapy will be effective, gastroenterologists prescribe a computed tomography, which reveals the structure, density, size of stones, contraction of the gallbladder after taking a choleretic breakfast.Without taking into account these data, it makes no sense to carry out lithorone-dissolving therapy. In any case, while the main method of treatment has been and remains the operative method.
– However, surgeons often say that the best surgery is the one that isn’t done.
– Yes, there is an opinion even in enlightened Petersburg that there is nothing superfluous in the body and if there is an opportunity to do without surgery, then it is better not to do it. This tactic leads to the fact that at least 40% of surgical interventions are carried out for emergency indications – patients develop acute cholecystitis or other complications of cholelithiasis requiring surgical intervention.But against the background of developed anatomical changes, inflammatory processes in the gallbladder and bile ducts, it is more traumatic, it has more risks of developing intraoperative complications (damage to nearby structures) and more difficult recovery. Planned intervention is much easier to tolerate, after which the person recovers safely. In addition, the age at which this occurs is also important. It is one thing to operate on a young person, whose recovery is fast, and another thing – on an elderly person with a number of concomitant diseases (coronary artery disease, hypertension).He needs to be prepared for surgery, otherwise, if operated on an emergency basis, the risk of an unfavorable outcome increases.
– You can understand a person who does not want to lie under the surgeon’s scalpel on the operating table …
– Laparotomy is a traumatic abdominal operation, fraught with serious complications, has long been in the past. With the advent of endovideosurgery, operations with extensive trauma on the anterior abdominal wall disappeared. Nowadays laparoscopic treatment of gallstone disease is called the gold standard.Our clinic offers the widest range of laparoscopic operations in the city.
Traditionally, they are made through 4 punctures and drainage is left in the early postoperative period. And we switched to the technology of three punctures – this reduces the pain syndrome and in the overwhelming majority of cases does not require drainage.
Often in patients, gallstone disease is combined with a developing umbilical hernia. In this case, we make an incision in the navel area (along the lower semicircle), all instruments are installed in the area of this incision, cholecystectomy is performed – through the same opening, the gallbladder is removed and at the end of the operation the umbilical hernia is removed.As a result, a small scar remains under the navel.
There are women who do not want to have even small scars in the abdomen after laparoscopic surgery. Then operations are performed using N.O.T.E.S. technology. through natural openings – the instruments are installed deep in the navel so that no one can subsequently detect the scar, and the actual operation is performed through the posterior fornix of the vagina (there are no pain receptors in this area), and the gallbladder is also removed through it. Everything is sutured with atraumatic absorbable suture so that the stitches do not need to be removed and there are no scars after the operation.
This technology is widely used in the world. Its difference from other operations is that the patient has less pronounced postoperative pain syndrome, the rehabilitation period is shorter and, accordingly, the person returns to an active life faster. In Russia, it is used in several medical centers, but our clinic has the richest experience. It is popular with young women who have stones that have been triggered by pregnancy and childbirth. And after this operation, they give birth again without any problems – this surgical intervention has no effect on reproductive function.
In our clinic, we practice simultaneous operations for several diseases in different anatomical areas. For example, a combination of ovarian cysts and gallstone disease. This approach allows you to simultaneously solve several problems with one anesthesia and one recovery period.
Gallstone disease is the presence of stones in the gallbladder and bile ducts.Stones are solid formations of various sizes made of cholesterol or bilirubin.
The disease can develop asymptomatically for a long time. As a result, stones clog the bile ducts and cause biliary colic, inflammation of the gallbladder, jaundice, and pancreatitis (inflammation of the pancreas).
This disease is widespread throughout the world and most often occurs in older women.
Treatment of gallstone disease consists in removing stones from the gallbladder or ducts.
If stones do not cause symptoms, their removal is not indicated.
Stones in the gallbladder and ducts, cholelithiasis, choledocholithiasis, gallstones.
Gallstones, Cholelithiasis, Choledoholitheasis, Gallstone in the bile duct, Bile duct stone.
Gallstones may not cause any symptoms for decades. If they block the bile ducts, causing tension in the gallbladder wall, this is manifested:
- Acute stabbing pain in the right upper abdomen, in the center of the abdomen;
- pain between the shoulder blades;
- pain in the right shoulder.
As a rule, a painful attack lasts 30-90 minutes. It can pass with increased sweating, nausea, and vomiting. In the absence of episodes of acute pain, patients usually do not complain.
The complicated course of the disease is sometimes accompanied by jaundice.
General information about the disease
Gallstone disease is the presence of one or more stones in the gallbladder and bile ducts.
The gallbladder is a small, pear-shaped, sac-shaped organ located on the right side of the abdomen below the liver.It is a “reservoir” for the bile produced by the liver. It passes into the cystic bile duct, which flows into the common bile duct.
The disease can develop unnoticed for a long time without causing any symptoms. It is widespread throughout the world and is most common in older women and obese people.
As a rule, stones form in the gallbladder. This occurs when cholesterol (a fatty substance) or bilirubin (a breakdown product of hemoglobin) is present in bile at an increased concentration.In this case, other components of bile cannot dissolve these substances. From bile, supersaturated with them, a sediment can form – microscopic crystals that settle on the mucous membrane of the gallbladder. Over time, the crystals grow and merge, gradually forming small stones. Gallstones can be composed of various substances:
- Cholesterol stones are the most common type of stones; consist mainly of cholesterol and are yellow;
- Pigment stones are less common and are small hard black stones or soft fatty stones of brown color; consist of the breakdown products of bilirubin.
The appearance of stones in the gallbladder or ducts can be caused by the following reasons.
- Hyper-saturation of bile with cholesterol due to …
- Excessive excretion of cholesterol in the bile (for example, in diabetes mellitus, high blood pressure, hyperlipidemia, obesity, while taking certain medications).
- Decrease in the production of bile salts, which make up the dry residue of bile and regulate the production of its other constituents, including cholesterol.
- Lecithin deficiency, the breakdown of which produces bile acids. This may be due to genetic disorders.
- Bile hyper-saturation with bilirubin. It leads to an increased formation of hemoglobin caused by sickle cell anemia (a hereditary disease that disrupts the structure of hemoglobin), cirrhosis of the liver (cicatricial degeneration of liver tissue).
- Impaired motility of the gallbladder and, as a consequence, its incomplete emptying and stagnation of bile, as in pregnancy, fasting, sudden weight loss, with spinal cord injuries.
- Certain parasites (eg liver fluke).
Gallstone disease has the following complications.
- Inflammation of the gallbladder (cholecystitis), which can cause severe pain in the upper right abdomen and fever.
- Blockage (obstruction) of the common bile duct. This can lead to jaundice or inflammation of the bile ducts (cholangitis).
- Blockage of the pancreatic duct – the tube through which juice that helps digest food from the pancreas through the common bile duct enters the duodenum.A blocked duct can cause pancreatitis, an inflammation of the pancreas.
- Cancer of the gallbladder. Gallstone disease increases the risk of developing gallbladder cancer.
Who is at risk?
- People over 60 years old.
- Persons who are overweight or obese.
- Pregnant women and women who have given birth several times.
- People who eat foods high in fat and low in fiber.
- Dramatically thinner.
- Persons with a hereditary predisposition to the development of the disease.
- Patients with diabetes mellitus.
- Those with high cholesterol levels.
- Persons taking certain medications (containing estrogens, etc.)
- Suffering from high blood pressure, liver cirrhosis.
Gallstone disease is suspected after the patient complains of acute pain in the right upper abdomen.Abdominal ultrasound can help determine the presence of stones. Often stones are discovered by accident when doing research for other purposes. A number of calcium-soaked stones can be seen on radiographs.
Laboratory research methods
Other research methods
- Abdominal ultrasound. This widely used test can detect gallstones with a high degree of accuracy.
- Computed tomography (CT) and magnetic resonance imaging (MRI) of the abdominal cavity.They are an alternative to ultrasound.
- Endoscopic retrograde cholangiopancreatography (ERCP) – examination of the bile ducts and pancreatic duct by introducing a radiopaque substance through a special probe.
Most people with gallstones do not need treatment: stones that do not cause symptoms should not be removed, and in some cases the disease is asymptomatic throughout a person’s life.However, gallstones must be removed in diabetes.
Treatment of gallstone disease depends on the symptoms of the disease and may include:
- Operation to remove the gallbladder (cholecystectomy), which is performed with frequent relapses and complications of the disease; removal of the gallbladder does not affect the vital functions of a person;
- taking medications aimed at dissolving gallstones.
To prevent complications of gallstone disease, the patient may be given a diet high in fiber and low in saturated fat.
To reduce the risk of developing gallstone disease, you should maintain a healthy diet, without taking long breaks between meals (more than 3-4 hours).
- Complete blood count
- Amylase total in serum
- Serum cholinesterase
- Aspartate aminotransferase (AST)
- Alanine aminotransferase (ALT)
- Phosphatase alkaline total
- Total bilirubin
- Glasgow RE, Mulvihill SJ.Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010: chap 66.
Every fifth person takes risks. What and how to eat to avoid cholesterol stones?
We talk a lot about cholesterol and plaque in blood vessels, but we rarely think about cholesterol stones in the gallbladder. But, according to statistics, every fifth person has them.And nutrition plays a significant role in their appearance. How to make a diet so that there are no such stones?
Every fifth risk is
Millions of people carry cholesterol stones in their gallbladders. According to statistics, they are found in 10-30% of adults. But these are average figures, among women the numbers are much higher: they have stones 3–8 times more often than men. This is due to female hormones. Both in connection with the presence of them in every woman, and with hormonal contraceptives – there is evidence that they can increase the risk of the formation of cholesterol stones in the gallbladder.
The main difficulty in identifying this problem is not even in some pains, but in the fact that due to the detection of stones, surgical operations are performed in which the gallbladder is removed. But this is a serious operation. Until recently, it was carried out in an open way, through a large incision, there were many complications and even deaths. Today it is usually done laparoscopically – through a “straw”, but it is still not an easy procedure. In reality, the operation is not shown to everyone. But at the same time, of course, the presence of such stones is not at all useful for health.
Tangle of diseases
And as numerous studies show, proper nutrition can help. The role of heredity in the development of this disease is 25%. And, therefore, diet and lifestyle can play a big role in preventing it. In addition, such a diet will help protect against many other diseases. After all, such stones in the gallbladder are tied into one “ball” with other metabolic diseases – metabolic syndrome, obesity, diabetes mellitus, dyslipidemia (increased cholesterol and blood lipids).
What and how to eat so that there are no stones?
Promotes stone formation. Fast food, meat (especially fatty), sugar and other easily digestible carbohydrates (sweet, starchy foods, soda), low fiber intake, very low-calorie diets (up to 1500 kcal per day), high fructose intake (diabetic foods, honey, soda with fructose), beans and other legumes, lack of vitamin C, overeating (excess calorie intake), prolonged fasting.
Protects against stone formation.Monounsaturated and polyunsaturated fats (vegetable oils), nuts, fiber (vegetables, fruits and whole grains), calcium (dairy products), moderate alcohol consumption, containing no more than 20-40 g of pure alcohol per day, coffee and caffeine, vitamin C and rich foods, a regular diet, a vegetarian diet, fish and fish oil, with low-calorie diets, it is important to consume enough fat (7-10 g per day).
Gastroenterologist, Doctor of Medicine, Professor of the Sechenov University Alexey Bueverov:
– Cholesterol stones account for 90% of all stones formed in the gallbladder.This is a very common condition and is more common in women. Moreover, if the mother has stones, then it is highly likely that the daughter will have them. They are more often diagnosed in obese people than in thin people. There is a theory that the formation of cholesterol stones is a side effect of the defense mechanism by which the liver takes excess cholesterol from the blood and directs it to the bile ducts, and then to the bladder.
Patients usually think that the presence of stones is indicated by a feeling of heaviness or aching and other pain in the right hypochondrium.This is not the case, stones do not cause such symptoms. And even if, against the background of such pains, they were identified, it is only a coincidence. In general, most often stones are discovered by chance during an ultrasound examination (ultrasound) for some other reason. It often happens that surgeons immediately suggest removing the gallbladder. It is wrong to do such an operation due to the presence of stones that do not bother.
For surgical treatment, there must be serious indications, for example, periodic exacerbations of the disease, biliary colic, blockage of biliary tract stones (due to this, jaundice occurs and there may be a rupture of the gallbladder).If the stones are not disturbing, the operation is not necessary. After removal of the gallbladder, the risk of developing fatty hepatosis (deposition of large amounts of fat in the liver) increases significantly. In addition, this organ has its own important function, it is involved in the exchange of bile acids.
If the stones are not old and no more than 3 cm in diameter, you can try to dissolve them. For this, drugs with ursodeoxycholic acid are used. Its action is associated with a certain natural phenomenon. In human bile, the content of this acid is 1–4%, and in the bile of a Himalayan bear – 90%, and therefore he never has gallstone disease.The acid prevents cholesterol from precipitating and helps dissolve stones. The drug with it must be used with the so-called sludge syndrome – the formation of cholesterol clots and their precipitation. This stage precedes the formation of stones and does not manifest itself with any symptoms. Usually it is also accidentally discovered during ultrasound.
If the stones are very large, it is better to remove them, as they contribute to the development of gallbladder cancer.