What are the potential long-term side effects of gallbladder removal. How does cholecystectomy impact digestion and overall health. Can you live a normal life without a gallbladder. What dietary changes are necessary after gallbladder surgery.

Understanding the Gallbladder’s Role in Digestion

The gallbladder, a small pear-shaped organ nestled beneath the liver, plays a crucial role in the digestive process. Its primary function is to store and concentrate bile produced by the liver. When we consume food, particularly fatty substances, the gallbladder contracts and releases bile into the small intestine. This bile aids in the breakdown and absorption of fats, facilitating efficient digestion.

Typically, the gallbladder can hold between 30 to 80 milliliters of bile fluid. This storage capacity allows for the timely release of bile when it’s most needed during the digestive process. The gallbladder’s ability to concentrate bile makes it more effective in emulsifying fats, which is essential for proper nutrient absorption.

The Gallbladder’s Contribution to Digestive Health

While the gallbladder is not an essential organ for survival, its presence optimizes the digestive process in several ways:

• Bile concentration: The gallbladder concentrates bile, making it more potent for fat digestion.
• Controlled release: It releases bile in response to food intake, ensuring efficient fat breakdown.
• Digestive timing: The gallbladder helps synchronize bile release with the presence of food in the small intestine.

Understanding the gallbladder’s role helps in appreciating the potential changes that may occur after its removal.

Gallstones: The Primary Reason for Gallbladder Removal

Gallstones are the most common reason for gallbladder removal, a procedure known as cholecystectomy. These hardened deposits of digestive fluid can form within the gallbladder, potentially causing severe discomfort and complications. Contrary to popular belief, not all gallstones cause symptoms. However, when they do, the pain can be intense and persistent, often necessitating surgical intervention.

Recognizing Gallstone Symptoms

Identifying gallstone symptoms is crucial for timely medical intervention. Common signs include:

• Sudden, intense pain in the upper right abdomen, often lasting more than 30 minutes
• Pain radiating to the back, particularly between the shoulder blades
• Nausea or vomiting
• Intolerance to fatty foods
• Abdominal bloating

If these symptoms persist or worsen, medical professionals may recommend gallbladder removal as the most effective treatment option.

Immediate Effects of Gallbladder Removal Surgery

Cholecystectomy, the surgical removal of the gallbladder, is a common procedure that typically results in relief from gallstone-related symptoms. However, patients often experience some immediate effects in the days and weeks following surgery.

Short-Term Recovery Expectations

In the immediate aftermath of gallbladder removal, patients may encounter:

1. Abdominal pain and discomfort at the surgical site
2. Temporary difficulty digesting fatty foods
3. Mild diarrhea or constipation
4. Fatigue and general weakness

These effects are generally short-lived, with most patients experiencing significant improvement within a few weeks post-surgery. However, it’s essential to follow post-operative care instructions diligently to ensure a smooth recovery.

Long-Term Side Effects of Gallbladder Removal

While many individuals adapt well to life without a gallbladder, some may experience long-term effects that persist beyond the initial recovery period. These effects can vary in severity and duration among patients.

Common Long-Term Digestive Changes

The most frequently reported long-term side effects of gallbladder removal include:

• Chronic diarrhea: Some patients experience persistent loose stools due to changes in bile flow.
• Constipation: Paradoxically, others may struggle with infrequent or difficult bowel movements.
• Fatty food intolerance: Without the gallbladder’s concentrated bile release, digesting high-fat meals can become challenging.
• Flatulence: Increased gas production in the digestive tract is common.
• Abdominal discomfort: Some individuals report ongoing mild pain or bloating.

It’s important to note that these effects don’t affect everyone, and many people lead normal lives post-cholecystectomy with minimal digestive disruptions.

Adapting to Life Without a Gallbladder

Adjusting to life after gallbladder removal often involves making certain lifestyle and dietary modifications. While these changes may seem daunting at first, most patients find that they can lead fulfilling, healthy lives with some mindful adjustments.

Dietary Recommendations Post-Cholecystectomy

One of the most crucial aspects of adapting to life without a gallbladder is modifying your diet. Consider the following dietary recommendations:

• Limit fat intake: Gradually reintroduce fats into your diet, focusing on healthier options like olive oil and avocados.
• Increase fiber consumption: This can help regulate bowel movements and prevent constipation.
• Eat smaller, more frequent meals: This approach can help your body better manage bile flow and digestion.
• Stay hydrated: Adequate water intake is essential for proper digestion and preventing constipation.
• Consider probiotics: These can help maintain a healthy gut microbiome and aid digestion.

By implementing these dietary changes, many individuals find significant improvement in their digestive comfort and overall well-being.

Managing Potential Complications After Gallbladder Removal

While most people recover without significant issues, some may experience complications following gallbladder removal. Being aware of these potential problems and knowing how to address them is crucial for long-term health management.

Recognizing and Addressing Post-Cholecystectomy Syndrome

Post-cholecystectomy syndrome (PCS) refers to a group of symptoms that some patients experience after gallbladder removal. These may include:

• Persistent abdominal pain
• Nausea
• Vomiting
• Flatulence
• Indigestion
• Diarrhea

If you experience these symptoms persistently after surgery, it’s important to consult with your healthcare provider. They may recommend additional tests or treatments to address underlying issues contributing to PCS.

The Impact of Gallbladder Removal on Overall Health

While the gallbladder plays a role in digestion, its removal doesn’t typically lead to significant long-term health issues for most people. However, it’s important to understand the potential systemic effects of living without a gallbladder.

Nutritional Considerations Post-Cholecystectomy

Without a gallbladder, the body’s ability to process certain nutrients may be affected. Consider the following nutritional aspects:

• Fat-soluble vitamin absorption: Vitamins A, D, E, and K may be less efficiently absorbed.
• Essential fatty acid intake: Omega-3 and omega-6 fatty acids remain important for overall health.
• Calcium absorption: Some studies suggest a potential link between gallbladder removal and decreased calcium absorption.

To mitigate these potential issues, maintaining a balanced diet rich in nutrients and considering supplements under medical supervision can be beneficial.

Long-Term Health Monitoring After Gallbladder Removal

While many individuals adapt well to life without a gallbladder, ongoing health monitoring is essential to ensure optimal well-being. Regular check-ups and awareness of potential long-term effects can help in maintaining good health post-cholecystectomy.

Recommended Follow-Up Care

After gallbladder removal, consider the following long-term health monitoring strategies:

1. Regular liver function tests: To ensure proper bile production and flow.
2. Periodic digestive health assessments: To address any persistent or new digestive issues.
3. Nutritional evaluations: To ensure adequate intake and absorption of essential nutrients.
4. Bone density scans: Particularly for those at risk of osteoporosis, given the potential impact on calcium absorption.

By staying proactive about your health post-surgery, you can address any emerging issues promptly and maintain a high quality of life.

Lifestyle Adjustments for Optimal Health Without a Gallbladder

Adapting to life after gallbladder removal often extends beyond dietary changes. Incorporating certain lifestyle adjustments can significantly enhance your overall well-being and help manage any lingering effects of the surgery.

Physical Activity and Exercise

Regular physical activity plays a crucial role in maintaining digestive health and overall wellness after gallbladder removal. Consider the following exercise recommendations:

• Start with low-impact activities: Walking, swimming, or yoga can be excellent options for gentle exercise.
• Gradually increase intensity: As your body adapts, you can introduce more vigorous activities.
• Focus on core-strengthening exercises: These can help support your digestive system and improve overall abdominal comfort.
• Stay consistent: Regular, moderate exercise is often more beneficial than sporadic intense workouts.

Remember to consult with your healthcare provider before starting any new exercise regimen, especially in the months immediately following surgery.

Managing Stress and Emotional Well-being Post-Surgery

The psychological impact of undergoing gallbladder removal and adjusting to life without this organ can be significant for some individuals. Addressing emotional well-being is an essential aspect of comprehensive post-surgical care.

Strategies for Emotional Adaptation

Consider implementing these strategies to support your emotional health after gallbladder removal:

1. Practice mindfulness or meditation: These techniques can help reduce stress and improve overall well-being.
2. Join support groups: Connecting with others who have undergone similar experiences can provide valuable emotional support and practical advice.
3. Maintain open communication with healthcare providers: Discuss any concerns or anxieties about your recovery and long-term health.
4. Engage in enjoyable activities: Pursuing hobbies and interests can help maintain a positive outlook during the adjustment period.

By addressing both physical and emotional aspects of recovery, you can achieve a more balanced and fulfilling life post-cholecystectomy.

Innovative Treatments for Post-Cholecystectomy Complications

As medical science advances, new treatments and interventions are being developed to address complications that may arise after gallbladder removal. Staying informed about these innovations can provide additional options for managing long-term effects.

Emerging Therapies and Interventions

Some promising developments in post-cholecystectomy care include:

• Bile acid sequestrants: Medications that can help manage chronic diarrhea by binding excess bile acids.
• Probiotics and prebiotics: Targeted supplements to support gut health and improve digestion.
• Minimally invasive procedures: Advanced techniques to address issues like bile duct stones or strictures.
• Neurostimulation therapies: Emerging treatments for managing chronic abdominal pain.

While these treatments may not be necessary for everyone, they represent expanding options for those experiencing persistent issues after gallbladder removal.

The Future of Digestive Health Management Post-Cholecystectomy

As our understanding of digestive health continues to evolve, so too does our approach to managing life after gallbladder removal. Ongoing research and technological advancements promise to further improve outcomes for individuals who have undergone cholecystectomy.

Personalized Medicine and Digestive Health

The future of post-cholecystectomy care may include:

1. Genetic testing to predict individual responses to gallbladder removal
2. Tailored nutritional plans based on personal digestive profiles
3. Advanced imaging techniques for more precise diagnosis of post-surgical complications
4. Development of artificial bile storage and release mechanisms

These potential advancements highlight the importance of ongoing medical follow-up and staying informed about new developments in digestive health management.

Living without a gallbladder presents unique challenges, but with proper care, informed decisions, and ongoing medical support, most individuals can lead healthy, fulfilling lives post-cholecystectomy. By understanding the potential long-term effects, implementing necessary lifestyle adjustments, and staying proactive about your health, you can effectively manage your digestive health and overall well-being for years to come.

Long-Term Effects of Gallbladder Removal

Persistent abdominal pain from gallstones may lead to a physician recommending gallbladder removal. The removal of the gallbladder usually causes a lot of concerns to a patient and their families. As a patient, you will start asking questions about what life is like post the surgical process, whether life will be normal and post-surgery effects that may change the trajectory of your life. With gallbladder removal, life should be normal with minimum life alteration. However, some people experience long-term effects. Here are some of the long-term effects of gallbladder removal.

What is the Function of the Gallbladder?

The gallbladder is a thin-walled pear-shaped sac located beneath the liver. It is responsible for concentrating and storing bile from the liver and releases bile into the small intestine to enhance the breaking down and absorption of fats from food. Research indicates that the gallbladder usually holds about 30 to 80 milliliters of bile fluid. It functions by releasing bile by contracting and squeezing through the bile duct when food reaches the small intestine. 

Gallstones Complications

The gallbladder may experience a gallstone complication leading to a cholecystectomy. The term “gallstones” is often associated with severe abdominal pain, which is not the case among most people. However, when the symptoms of gallstones persist, your physician may recommend a procedure for removing the gallbladder.

Symptoms of Gallstones

Here are some of the symptoms of gallstone that may lead to gallbladder removal:

• Intolerance of fatty foods
• Abdominal bloating
• Severe pain in the upper abdomen lasting more than 30 minutes
• Back pain, particularly between your shoulders and beneath your right shoulder.
• Nausea or vomiting

Gallbladder Removal Side Effects

Generally, gallbladder removal effects may be felt in the first six months after the procedure. However, in some cases, it may have long-term effects on individuals. Some of these long-term effects include

• Diarrhea
• Constipation
• Fatty food intolerance
• Flatulence, or the accumulation of gas in the alimentary canal

Most of the impacts of gallbladder removal may be felt by lifestyle and dietary changes one makes in their schedule. Individuals may also find it difficult to handle hard tasks post-removal. In case of severe effects, it is important to consult your physician for further guidance.

Learning to Cope With These Effects

It is important to understand the various coping mechanisms you can adopt after removing the gallbladder. Adjustments may feel uncomfortable at first, but with time one gets used to them and adopts a new way of life. Some of the ways to cope with these effects of gallbladder removal include the following:

Limit Fat Intake: Gallbladder removal may reduce the action of bile. It is important to reduce fat intake since one may become fat intolerant. As a dietary adjustment, one should consume steamed, baked, boiled, or grilled foods and avoid fried foods which contain fats.

Lifestyle adjustments: It is important to adjust your lifestyle and activities in the long term to enhance comfort. One needs to be aware of their condition and be mindful of their activities, such as exercises, what to ingest, and the duration between eating to avoid challenges such as bloating.

Incontinence After Gallbladder Surgery

Most people who have experienced gallbladder removal live a normal life. However, proper adjustment often comes with adequate coping mechanisms, such as lifestyle changes and limiting fat intake, so one can easily adapt post-surgery. A small percentage of patients also experience incontinence after gallbladder surgery. If you’re experiencing incontinence as a result of gallbladder surgery, contact us to speak to a medical concierge about your symptoms and find the right solution. The Incontinence Institute offers a network of specialized physicians focused on long-term solutions. You can also reach us by phone at 1 (615) 434-8661 or by filling out a fecal incontinence self-assessment or urinary incontinence self-assessment.

Gallbladder Removal Surgery: Side Effects and Complications

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Some people may experience side effects from gallbladder removal, ranging from diarrhea and difficulty digesting fat to intestinal injury and infection.

The gallbladder is a small pouch-like organ on the right side of your abdomen. Its job is to store and release bile, a substance made by the liver to help you digest fats.

The most frequent forms of gallbladder disease arise from having too much cholesterol or bilirubin, a liver pigment, in your bile. This leads to:

• gallstones
• acute or chronic inflammation caused by gallstones
• bile duct stones

If symptoms become too uncomfortable or interfere with your health, doctors may suggest either open or laparoscopic gallbladder removal.

Fortunately, you can live a healthy life without your gallbladder, and the surgery to remove it is relatively simple. Without a gallbladder, bile can move directly from your liver to your intestines to aid in digestion. However, there’s still some chance that you might experience side effects after gallbladder removal.

Any surgery has potential complications, including incision bleeding, movement of surgical materials to other parts of the body, pain, or infection — with or without a fever. It’s possible you’ll experience digestive side effects when your gallbladder is removed.

Difficulty digesting fat

It may take your body time to adjust to its new method of digesting fat. The medications you were given during surgery may also cause indigestion. This doesn’t typically last long, but some patients do develop longer-term side effects, usually caused by bile leaking into other organs or gallstones that were left behind in the bile ducts.

Diarrhea and flatulence

Indigestion can cause diarrhea or flatulence, often made worse by excess fat or too little fiber in the diet. Bile leakage can mean having an insufficient amount of bile in the intestines to digest fat, which loosens stool.

Constipation

Although removal of a diseased gallbladder usually reduces constipation, surgery and anesthesia used during the procedure can lead to short-term constipation. Dehydration can make the constipation worse.

Intestinal injury

During gallbladder removal, it’s rare but possible for a surgeon to damage the intestines. This may result in cramping. Some pain is normal following any surgery, but if it continues beyond a few days or gets worse instead of better, speak to your doctor.

Jaundice or fever

A stone that remains in a bile duct after gallbladder removal surgery can cause severe pain, or jaundice, which is the yellowing of the skin. A complete blockage can cause an infection.

If there are no complications, your recovery from gallbladder surgery should go smoothly.

To increase the chances of success, your doctor may suggest that you remain in the hospital for three to five days if you have open surgery. If you have keyhole, or laparoscopic, surgery, you may be able to go home the same day.

Either way, try not to physically strain yourself for at least two weeks.

Your medical team will teach you how to clean your wounds and watch for infection. Don’t shower until you get the green light from your doctor.

Your doctor may prescribe a liquid or bland diet for the first few days. After that, they’ll probably suggest adding back your usual foods, little by little. Drink water throughout the day. It’s also a good idea to eat simple fruits and vegetables while limiting highly salty, sweet, spicy, or fatty foods.

Fiber is essential for good digestion after surgery, but limit your initial intake of the following:

• nuts
• seeds
• whole grains
• brussels sprouts
• broccoli
• cauliflower
• cabbage
• high-fiber cereals

Although it’s normal to have some side effects after surgery, if you notice any of the following, contact a doctor right away:

• pain that doesn’t get better with time, new abdominal pain, or pain that gets worse
• intense nausea or vomiting
• yellowing of your skin or the whites of your eyes
• no bowel movement or passing of gas for more than three days after surgery
• diarrhea that continues for three or more days following surgery

Gallbladder removal is a last resort. If your doctor doesn’t feel that surgery is urgent, you may want to try lifestyle changes first.

Diet and exercise

Reaching and maintaining a healthy weight can reduce pain and complications from gallbladder disease by reducing the cholesterol and inflammation that can cause gallstones.

A diet lower in fat and higher in fiber, and full of fruits and vegetables, can also improve gallbladder health. Swap animal fats, fried foods, and oily packaged snacks for olive oil and other healthy fats. Limit or avoid sugar.

Regular exercise can help your body reduce cholesterol and prevent gallstones from forming. Magnesium deficiency can increase your risk of developing gallstones. Eat magnesium-rich foods, including dark chocolate, spinach, nuts, seeds, and beans to improve gallbladder health.

Gallbladder cleanse

A gallbladder cleanse usually refers to avoiding food for up to 12 hours, then drinking a liquid recipe like the following: 4 tablespoons of olive oil with 1 tablespoon of lemon juice every 15 minutes for two hours.

Tonics

Apple cider vinegar and turmeric both have been shown to reduce inflammation. If you mix them with warm water you can enjoy them as a tea-like drink and may experience relief of your gallbladder symptoms. Some people find the menthol in peppermint tea to be soothing as well.

Some studies have shown the benefits of turmeric on gallstone formation. However, if you have gallstones, be careful how much turmeric you ingest. One 2002 study with 12 healthy participants showed 50 percent contraction of the gallbladder due to curcumin. This increased contraction could cause pain.

Supplements

In addition to magnesium, choline plays a role in gallbladder health.

According to the Harvard Health Letter, bile salts may be worth a try as well, especially if your liver has been producing thick bile. Bile acids also come in prescription strength.

Speak to a doctor or nutritionist about taking one or more of these supplements if you have gallstones or a blocked bile duct.

Acupuncture

Acupuncture may be of potential benefit to those with gallbladder disease. It most likely works by increasing the flow of bile while also reducing spasms and pain.

It’s important to note that although diet and exercise are proven methods of reducing gallbladder complications, other methods like cleanses, tonics, and supplements haven’t been studied extensively, and side effects may occur. Be sure to discuss these options with your healthcare provider before proceeding.

Gallbladder removal is a fairly common procedure, but it’s always possible that you may experience some side effects. Knowing how to identify and reduce symptoms, side effects, and complications before and after surgery may make for an easier experience.

Complications after removal of the gallbladder

That is why we at GMS Hospital strictly adhere to international protocols and do not remove the gallbladder in case of asymptomatic cholelithiasis (and this is 80% of patients), when the risk of complications of the disease itself and the risk of negative consequences of the operation is the same, and is about 2%.

You can read more about gallstone disease, risk factors and our approach to its treatment here.

Yes, GMS Hospital has excellent modern equipment and experienced surgeons who strictly adhere to the principles of “safe cholecystectomy”, and the number of complications in our clinic is an order of magnitude lower than the above data from international studies. But, nevertheless, we always remember the possible negative consequences of removing the gallbladder, and we recommend surgery only in case of symptomatic or complicated course of gallstone disease: in this case, the risk of acute cholecystitis, pancreatitis, cholangitis, etc. increases by about 10 times , and an order of magnitude higher than the likelihood of problems after surgery.

Complications after cholecystectomy

All complications of cholecystectomy can be divided into two large groups – arising directly during or immediately after surgery and long-term complications.

Directly during the operation, the surgeon may experience bleeding and inadvertent damage to the common bile duct.

Bleeding can develop during any operation, in fact, every, even the smallest tissue incision leads to a slight bleeding. Deep knowledge of the anatomical structure of the surgical intervention area, high-quality image (and the equipment in our operating room is at least HD-class video), the use of modern surgical energies (mono- and bipolar coagulation, ultrasonic scissors), precise work of surgeons – make laparoscopic cholecystectomy performed in GMS The hospital is practically bloodless.

Damage to the common bile duct is perhaps the most formidable complication of cholecystectomy. World statistics speak of a 0.4%–4% probability of crossing the common bile duct or one of the hepatic ducts – and this is, at a minimum, disability and complex reconstructive surgery for the patient. “Light” injury, including electrical injury, is the cause of the development of persistent narrowing (stricture) of the bile ducts, which in turn leads to other long-term consequences, including cholangitis and the formation of stones already in the common bile duct after surgery.

To avoid these negative consequences, the world’s leading experts have developed the principles of “safe cholecystectomy”, which are mandatory for our surgeons. And this could not but give a result: we are very proud that from the moment of its foundation in the clinic there was not a single case of damage to the bile ducts during the removal of the gallbladder.

Pulmonary embolism (PE) is another potentially life-threatening postoperative complication that is much easier to prevent than to treat. This is the formation of blood clots, most often in the veins of the legs, which, after surgery, can come off and get into the heart, and then into the vessels of the lungs.

A whole system of measures has also been developed for the prevention of pulmonary embolism. For each patient, GMS Hospital determines the individual risk of thromboembolic complications, based on the planned operation, the patient’s existing risk factors (the presence of cancer, blood coagulation disorders (thrombophilia), advanced age, high body mass index, etc. ). Knowing exactly the degree of risk, we select a method of prevention. All patients, without exception, undergo elastic compression of the lower extremities, and at medium and high risk, we use low molecular weight heparins and / or intermittent pneumocompression using special equipment (which we have in every operating room). The use of laparoscopic technologies (namely, they make up 99%, and not only in gallbladder disease) by itself significantly reduces the risk of thromboembolism compared with open cholecystectomy.

Postcholecystectomy syndrome (PCES)

Long-term consequences of cholecystectomy is the so-called postcholecystectomy syndrome (PCS).

Based on the definition, PCES is any problems with the gastrointestinal tract after the removal of the gallbladder. Thus, under this concept, quite a lot of diseases can be adjusted, some of which (and, I must say, most) have nothing to do with the operation.

What can cause PCES?

• Diseases of other organs: gastroesophageal reflux disease (GERD), gastric or duodenal ulcer, irritable bowel syndrome, chronic pancreatitis, hepatitis, mesenteric ischemia, diverticular disease of the colon, intercostal neuralgia, coronary heart disease and a number of other diseases.

  Why are these diseases referred to as postcholecystectomy syndrome? Most often this happens as follows: the patient comes to the doctor with complaints that are caused, for example, by duodenal ulcer (aching pain in the upper abdomen). With ultrasound, stones are found in the gallbladder – and they are removed. After the operation, the symptoms were as they were – the ulcer has not gone away. But now, when the patient comes to the gastroenterologist, he calls it “postcholecystectomy syndrome” – after all, the gallbladder has been removed. The clinic doctor often has neither the time nor the desire to deal with the causes of pain in detail. Hence the large amount of PCES, reaching, according to various studies, 5-30%. The true postcholecystectomy syndrome in this case is no more than 10%, and in our practice it is much less (because we do not operate when it is not necessary, and we are looking for the true cause of pain before surgery, not after).

  At the same time, we must not forget that after cholecystectomy, the physiological interaction of the organs of the gastrointestinal tract, the nervous and humoral regulation of their work do change. And this can lead to an increase in the incidence of, for example, gastritis or gastroesophageal reflux.

• True postcholecystectomy syndrome, that is, diseases that are associated with the biliary system:
• Strictures (narrowings) of the common bile duct, leakage of bile into the abdominal cavity, chronic biloma (accumulation of bile) or abscess of the subhepatic space, “forgotten” stones of the common bile duct, left long cystic duct and stones left in the abdominal cavity when the gallbladder ruptures during surgery , also leading to the formation of abscesses in the postoperative period.
• All these problems are the result of technical or tactical errors of the surgeon during or before the operation (insufficient examination for the presence of stones in the common bile duct, for example). There is only one way to avoid (or at least minimize the risk of their occurrence) – a thorough preoperative assessment of the clinical situation and strict adherence to the principles of “safe cholecystectomy”.
• Dysfunction of the sphincter of Oddi – Causes symptoms similar to biliary colic – quite intense pain in the right hypochondrium. May be the result of cicatricial stenosis (most often occurs due to the repeated passage of small stones through the large duodenal papilla, in which this sphincter is located) or its spasm.
  To diagnose this condition, ultrasound is performed against the background of a painful attack, MR cholangiography and a biochemical blood test can also help.

Pain with spasm of the sphincter of Oddi is relieved by nitrates and calcium channel blockers. The most effective method of treatment today is recognized as endoscopic papillosphincterotomy (dissection of the major duodenal papilla during endoscopic examination). However, it should be remembered that this manipulation in itself can lead to rather unpleasant complications – bleeding and acute pancreatitis. Therefore, before going for the dissection of the sphincter of Oddi, a very thorough diagnosis is necessary, up to endoscopic manometry (determination of the degree of sphincter compression using a special sensor), which, unfortunately, is not always technically possible to do in conventional clinics.

Diarrhea after gallbladder removal

Postcholecystectomy diarrhea is perhaps the most common manifestation of postcholecystectomy syndrome. It is based on several reasons: a violation of the reverse absorption of fatty acids, non-compliance with the diet (primarily the use of large amounts of fat), the use of antibiotics for acute cholecystitis, the manifestation of irritable bowel syndrome, etc.

According to the data, diarrhea occurs in 17% of patients after removal of the gallbladder. Most often, it disappears during the first weeks after surgery, and after 3 months it persists only in 5.7% of patients.

The main controllable risk factor for developing diarrhea is the restriction of fatty foods. Most often, dieting allows you to quickly adjust the chair; if this is not enough, we use bile acid sequestrants (drugs such as cholestyramine), which allow us to cope with this problem almost always.

Diet after gallbladder removal

To understand the basic principles of the diet after removal of the gallbladder, remember what functions it performs.

The gallbladder accumulates bile, concentrates it, removing excess water, and releases it into the duodenum 12 when fats come in with food. The main function of bile is to emulsify fats, that is, it “breaks” them into small fragments (micelles). Only micellar fat can be broken down by pancreatic enzymes into triglycerides and fatty acids.

After the removal of the gallbladder, these functions are lost (it must be said that the patient with gallstone disease already has their original impairment). Bile now flows into the duodenum constantly, in its original, unconcentrated form, and there is relatively little bile in the duodenum at any given time (compared to a person with a normally functioning gallbladder).

Hence the basic principles of nutrition:

Bile flows constantly – you need to eat more often

It is not concentrated and there is relatively little of it at any given time – small portions and fat restriction. The bile that is now in the duodenum should be enough to emulsify them.

If you break the diet, no catastrophe will happen, but the available bile is not enough to emulsify fats, they cannot be broken down by pancreatic enzymes and travel undigested through the small intestine to the large intestine and are evacuated from the body as quickly as possible. It will be unpleasant due to spasm and diarrhea, but once again – no disaster will happen.

Nevertheless, dieting is an important part of postoperative recovery and prevention of the same postcholecystectomy syndrome that we discussed above.

However, rumors about the need for strict adherence to diet number 5, which is often recommended after cholecystectomy, are greatly exaggerated. It is enough to follow the principles that we outlined above. The closest to the optimal diet after gallbladder removal is the Mediterranean, but we must remember that the diet is no less important than the foods you eat.

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Cholecystectomy: indicators, methods, rehabilitation – operations in Moscow, favorable prices at the international clinic Medica24

Cholecystectomy is a surgical procedure during which the gallbladder is removed. In modern clinics, it is usually performed laparoscopically – without an incision, through small punctures in the abdominal wall. For a surgeon with relevant experience, this is a routine operation that is not difficult. Patients tolerate laparoscopic cholecystectomy well, the risk of complications is low. Discharge from the hospital can be carried out on the next day after the intervention.

Our expert in this area:

Semushin Valentin Valentinovich

Oncologist, surgeon

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Open cholecystectomy through an incision is associated with slightly higher risks, after which the recovery period is longer. Currently, this type of operation is used only in certain cases.

Indications for cholecystectomy

The gallbladder is a small sac-like organ located on the lower surface of the liver. Its volume in an adult reaches 50–60 cm³. Anatomically, it distinguishes the bottom, body and neck, which passes into the cystic bile duct. The latter connects to the common hepatic duct, and together they form the common bile duct. Connecting with the pancreatic duct, it flows into the duodenum.

The gallbladder is used to store bile. When food enters the duodenum from the stomach, it contracts and secretes 40–60 ml of bile. It is necessary for normal digestion. However, the gallbladder, affected by the pathological process, ceases to perform its work normally and becomes only a source of problems: it causes pain, turns into a reservoir for infection, disrupts the function of the biliary tract and pancreas. Cholecystectomy helps to completely get rid of all symptoms in 90-95% of cases.

One of the most common indications for cholecystectomy is cholelithiasis. Surgical treatment is resorted to when there are stones in the gallbladder that cause symptoms:

• Attacks of biliary colic – sharp, sharp, very severe pain under the right rib. In 2/3 of patients, after the first such attack, a second one occurs within two years. Some develop serious complications later. If episodes of acute pain are repeated, this is a clear indication for surgery.
• “Small” symptoms: taste of bitterness in the mouth, feeling of discomfort, heaviness under the right rib after eating, aching pain. In 6 to 8% of these patients, emergencies occur annually, so the doctor may suggest elective cholecystectomy.

If gallstones do not cause symptoms, then surgical treatment may be recommended for large stones (2.5-3 cm – due to the risk of pressure ulcers), hemolytic anemia, operations for obesity (the course of gallstones may worsen after sudden weight loss ), with a patient’s life expectancy of more than 20 years (since the risk of complications increases over time).

Other indications for cholecystectomy in a planned manner:

• Chronic calculous cholecystitis – the formation of stones in the gallbladder and inflammation of its wall. The disease is most common in older women.
• Polyps are abnormal growths on the wall of the gallbladder. The causes of their occurrence are not fully understood, they often do not cause symptoms and are an accidental finding during ultrasound.
• “Porcelain” gallbladder – a condition in which the wall of the organ is covered with a layer of calcium. Its main cause is prolonged inflammation. These patients have an increased risk of developing cancer.
• Past attack of acute cholecystitis. Elective cholecystectomy is recommended within the next 4 to 6 weeks, with a maximum of 12 weeks.
• Past attack of acute biliary pancreatitis – inflammation in the pancreas caused by problems with the gallbladder. Usually the causes are gallstones, inflammation, anatomical features. The patient is prepared for surgery as soon as the manifestations of pancreatitis subside.
• Acalculous cholecystopathy (dyskinesia of the gallbladder) is a dysmotility of the gallbladder, which is accompanied by distressing symptoms. This indication is not absolute. In Russia, cholecystectomy is performed with it only in certain cases when drug therapy is ineffective.
• Gallbladder cancer. For malignant tumors, extended radical cholecystectomy is usually performed. Often the gallbladder is removed for another reason, and after the operation, according to the results of the biopsy, tumor cells are found in it.

Urgent removal of the gallbladder – within the next 48-72 hours – is indicated for acute cholecystitis when drugs do not help or complications develop. This is a dangerous pathology in which up to 1-6% of patients die. Acute cholecystitis can be complicated by such life-threatening conditions as necrosis (death), perforation (formation of a through hole) of the gallbladder wall and the development of peritonitis (inflammation in the abdominal cavity), intraperitoneal abscess (abscess), sepsis (systemic inflammation – “blood poisoning” ).

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Contraindications

When it comes to saving the patient’s life, cholecystectomy through the incision can almost always be performed. Laparoscopic interventions have more contraindications.

The main absolute contraindications include a very poor, terminal condition of the patient, severe disorders of the internal organs, uncontrolled coagulopathy (deterioration of blood clotting), threatening dangerous bleeding during surgery.

In some cases, cholecystectomy can only be performed by an open method:

• cicatricial changes or severe inflammation in the gallbladder;
• adhesions in the abdominal cavity;
• comorbidities that require a full examination of the abdominal cavity;
• difficult view during laparoscopy due to anatomical features;
• bleeding during surgery;
• malformations of the biliary system;
• widespread peritonitis.

Technologies are improving, so the indications for laparoscopic cholecystectomy have expanded significantly in recent years. So, this type of operation has become possible to perform in the elderly, pregnant women (most safely in the second trimester), obese people with cirrhosis of the liver (but not always), acute cholecystitis, and previous operations on the abdominal organs. Make an appointment with a surgeon at the international clinic Medica24: the doctor will assess your situation and determine the optimal surgical tactics.

Preparation for surgery

To make a decision about the need for cholecystectomy, it is necessary to conduct an examination of the biliary system. The doctor may prescribe ultrasound, endoscopic ultrasonography (ultrasound using a probe located at the end of the endoscope), magnetic resonance cholangiography, endoscopic retrograde cholangiopancreatography (ERCP), and other diagnostic procedures.

Then, during the preliminary consultation, the surgeon explains to the patient what type of intervention is planned to be performed, what it is for, what is the expected result. The patient should tell the doctor about his concomitant diseases, allergic reactions, drugs that he constantly takes.

Next, the doctor sets the date of hospitalization and surgical intervention, issues a list of studies and tests that need to be done as part of the preoperative examination. It usually includes general blood and urine tests, a biochemical blood test, a blood coagulation test, tests for HIV, syphilis and viral hepatitis, determination of the blood group and Rh factor, ECG, fluorography, consultation with a therapist and, if necessary, other specialist doctors.

A light dinner before 19 is recommended the day before the operation.00 Then you can’t eat or drink anything, because the intervention is performed under general anesthesia. In the evening and in the morning, a cleansing enema is done. In the morning you need to take a shower.

In acute cholecystitis, preoperative preparation is carried out in an accelerated manner, limited to the minimum required set of procedures.

How is cholecystectomy performed?

There are different techniques for performing cholecystectomy, each of which has its own advantages and disadvantages, and is optimal in certain cases.

Laparoscopic cholecystectomy

Currently, gallbladder removal is most often performed laparoscopically. Usually, the operation is performed through 3-4 punctures in the abdominal wall, in some cases more may be required. One of the punctures is made in the navel area, through which a laparoscope is inserted – an instrument with a video camera and a light source. An insufflator is also connected to the laparoscope, through which the abdominal cavity is filled with carbon dioxide. This is necessary to provide the surgeon with a good view and space for manipulations.

Special surgical instruments are inserted through the remaining punctures. With the help of them, the cystic duct and artery are carefully isolated, clamped with clips and crossed. After the gallbladder is isolated, it is removed through one of the punctures.

When the operation is completed, the instruments are removed and the incisions are sutured.

Operation through one puncture

In recent years, an improved method of laparoscopic removal of the gallbladder has been actively developed – single-port cholecystectomy. In this case, only one puncture is made in the navel area. A laparoport is installed in it, through which several instruments can be inserted at once. Such interventions are optimal for uncomplicated chronic calculous cholecystitis. Their main advantage is an excellent cosmetic effect, the absence of a noticeable scar.

Open cholecystectomy

In open cholecystectomy, the surgeon makes a vertical incision in the middle of the abdomen (median laparotomy) or an oblique incision under the right lower costal arch. The gallbladder is isolated, ligated (or clipped) and transected in the same way as during laparoscopic intervention.

As noted above, in some cases, open surgery is the best option, because during it the surgeon can fully examine the gallbladder and neighboring organs, as well as conduct intraoperative studies:

• probing the bile ducts and measuring their width;
• cholangiography;
• choledochotomy (opening of the bile ducts) and endoscopic examination;
• ultrasound.

Minimally invasive open cholecystectomy

In some cases, minimally invasive surgery can be performed with a small incision 3-5 cm long in the right hypochondrium. Such an intervention has many advantages of open cholecystectomy, but is accompanied by less tissue trauma, after which the hospitalization and recovery period are shorter.

Extended radical cholecystectomy

This is the most complex operation performed for malignant tumors. If only the gallbladder is removed for cancer, then the risk of recurrence is high. The minimum volume of the operation involves the removal of the gallbladder, a few centimeters of adjacent liver tissue, and all nearby lymph nodes.

In some cases, part of the liver, common bile duct, pancreas, additional groups of lymph nodes, duodenum and other organs affected by a malignant tumor may be removed.

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Rehabilitation period

4-6 hours after laparoscopic cholecystectomy, the patient is allowed to get out of bed and drink small amounts of water. The next day, the patient can already move freely, he is allowed to take liquid food. Many patients are discharged home after one night in the hospital, some are left for another day.

Usually, after removal of the gallbladder, a drain is left in the abdominal cavity – a tube for the outflow of fluid. It is removed the next day. In the first days, pain may disturb, they are removed with painkillers. In some patients, antispasmodics are used for a week. Also, the doctor may prescribe drugs that improve the properties of bile.

A diet must be followed for a month after the operation. Tea and coffee, fatty, fried foods, sweets, and any drinks containing alcohol are prohibited. Then the patient gradually returns to his usual diet under the supervision of a gastroenterologist. Also, within a month, you need to limit physical activity: avoid tension in the abdominal muscles, do not lift loads heavier than 3-4 kg.

After open cholecystectomy, the patient spends more time in the hospital, the rehabilitation period lasts longer.

Possible complications

Cholecystectomy, like any surgical intervention, is accompanied by the risk of some complications:

• Biliary leakage is a condition when bile is released from the drainage tube. Often it is not dangerous and stops on its own, as soon as the tissues in the area of ​​the gallbladder bed heal. This slightly increases the duration of hospitalization. But sometimes bile leakage indicates a serious complication – damage to the bile ducts. This requires repeated surgery.
• Bleeding.
• Infectious complications.
• Damage to the liver, intestines.
• Thromboembolism is a condition in which a blood clot forms in the veins, usually of the lower extremities, from which a fragment can then come off. It is able to migrate with the blood flow to other vessels and cause their blockage. For example, this is how a life-threatening complication develops – pulmonary embolism.
• Reactions to drugs for anesthesia.
• Pneumonia – inflammation of the lungs. This complication can be caused by general anesthesia, the ingress of stomach contents into the respiratory tract.
• Exacerbation of peptic ulcer of the stomach and duodenum.

In most cases, after gallbladder removal, there are no digestive problems in the long term. This body does not play a critical role. In some patients, the stool becomes liquid, over time it normalizes.

In 5–40% of cases, the so-called postcholecystectomy syndrome develops. The nature of this state is not completely clear. There are suggestions that it is a continuation of the disease, due to which the bile ducts had to be removed. It is also possible that this is a consequence of the operation itself. Postcholecystectomy syndrome manifests itself in the form of periodic aching pain in the right hypochondrium, nausea, belching, bloating, loose stools, loss of appetite. The treatment of this condition is medication: painkillers, enzymes, drugs that suppress secretion in the stomach.