Bile Duct Obstruction: Symptoms, Causes & Treatments

A bile duct obstruction is a blockage in one of the tubes that carries bile. Bile is a product of the liver. It contains cholesterol, bile salts to help digest fats, and waste products, such as bilirubin.

After the liver makes bile, it travels through a network of microscopic tubes called hepatic ducts. These small ducts meet to form one large duct, called the common hepatic duct. Bile exits the liver through this duct. About half the bile goes into the small intestine (starting with the duodenum) and the rest goes to the gallbladder for storage. The gallbladder releases stored bile into the small intestine when food from a meal triggers it. Bile from the gallbladder flows through a different pathway, called the cystic duct. The cystic duct meets the common hepatic duct from the liver to form the last bile duct, called the common bile duct. A blockage in any of these tubes is a bile duct obstruction.

The most common cause of a bile duct obstruction is a gallstone. Gallstones form inside the gallbladder and can move into the common bile duct, blocking it. Cysts, tumors, inflammation and scarring are other bile duct obstruction causes.

Bile duct obstructions are more common in people with a history of or at high risk of gallstones. Surgery or injury to the liver, gallbladder, or biliary network can also increase the risk.

When a blockage occurs in any of the bile ducts, bile accumulates within nearby structures. As bile builds up in the liver, it causes jaundice and other symptoms, such as nausea, vomiting, and upper abdominal pain. Depending on the cause, these symptoms can develop abruptly or slowly with time. For example, gallstones may cause severe, acute symptoms. Tumors may cause a more gradual onset of symptoms.

Bile duct obstruction treatment usually involves surgery or an endoscopic procedure. The cause of the obstruction will determine what kind of surgery or procedure is necessary.

Left untreated, a bile duct obstruction can cause life-threatening complications. This includes infection, sepsis, and liver damage. Call your doctor right away if you notice symptoms of jaundice, such as yellow skin or eyes, dark urine, or pale stools. Seek immediate medical care for severe abdominal pain, high fever and chills, or persistent nausea and vomiting.

Bile Duct Obstruction: Symptoms, Causes & Treatments

A bile duct obstruction is a blockage in one of the tubes that carries bile. Bile is a product of the liver. It contains cholesterol, bile salts to help digest fats, and waste products, such as bilirubin.

After the liver makes bile, it travels through a network of microscopic tubes called hepatic ducts. These small ducts meet to form one large duct, called the common hepatic duct. Bile exits the liver through this duct. About half the bile goes into the small intestine (starting with the duodenum) and the rest goes to the gallbladder for storage. The gallbladder releases stored bile into the small intestine when food from a meal triggers it. Bile from the gallbladder flows through a different pathway, called the cystic duct. The cystic duct meets the common hepatic duct from the liver to form the last bile duct, called the common bile duct. A blockage in any of these tubes is a bile duct obstruction.

The most common cause of a bile duct obstruction is a gallstone. Gallstones form inside the gallbladder and can move into the common bile duct, blocking it. Cysts, tumors, inflammation and scarring are other bile duct obstruction causes.

Bile duct obstructions are more common in people with a history of or at high risk of gallstones. Surgery or injury to the liver, gallbladder, or biliary network can also increase the risk.

When a blockage occurs in any of the bile ducts, bile accumulates within nearby structures. As bile builds up in the liver, it causes jaundice and other symptoms, such as nausea, vomiting, and upper abdominal pain. Depending on the cause, these symptoms can develop abruptly or slowly with time. For example, gallstones may cause severe, acute symptoms. Tumors may cause a more gradual onset of symptoms.

Bile duct obstruction treatment usually involves surgery or an endoscopic procedure. The cause of the obstruction will determine what kind of surgery or procedure is necessary.

Left untreated, a bile duct obstruction can cause life-threatening complications. This includes infection, sepsis, and liver damage. Call your doctor right away if you notice symptoms of jaundice, such as yellow skin or eyes, dark urine, or pale stools. Seek immediate medical care for severe abdominal pain, high fever and chills, or persistent nausea and vomiting.

Cholangitis | Johns Hopkins Medicine

What is cholangitis?

Cholangitis is an inflammation of the bile duct system. The bile duct system carries bile from your liver and gallbladder into the first part of your small intestine (the duodenum).

In most cases cholangitis is caused by a bacterial infection, and often happens suddenly. But in some cases it may be long-term (chronic). Some people develop inflammation and cholangitis as part of an autoimmune condition.

What causes cholangitis?

In most cases cholangitis is caused by a blocked duct somewhere in your bile duct system. The blockage is most commonly caused by gallstones or sludge impacting the bile ducts. Autoimmune disease such as primary sclerosing cholangitis may affect the system.

Other, less common causes of cholangitis include:

• A tumor
• Blood clots
• A narrowing of a duct that may happen after surgery
• Swollen pancreas
• A parasite infection

Cholangitis may also be caused when you have:

• A backflow of bacteria from your small intestine
• A blood infection (bacteremia)
• A test done to check your liver or gallbladder (such as a test where a thin tube or endoscope is put into your body)

The infection causes pressure to build up in your bile duct system, which can spread to other organs of the bloodstream if it is not treated.

Who is at risk for cholangitis?

If you have had gallstones you are at greater risk for cholangitis. Other risk factors include:

• Having autoimmune diseases such as inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• Recent medical procedures involving the bile duct area
• Having human immunodeficiency virus (HIV)
• Traveling to countries where you might be exposed to worms or parasites

What are the symptoms of cholangitis?

Each person’s symptoms may vary, and may be non-specific or severe, including: 

• Pain in the upper right part of your belly (abdomen)
• Fever
• Chills
• Yellowing of the skin and eyes (jaundice)
• Nausea and vomiting
• Clay-colored stools
• Dark urine
• Low blood pressure
• Lethargy
• Changes in alertness

The symptoms of cholangitis may look like other health problems. Always see your healthcare provider to be sure.

How is cholangitis diagnosed?

The pain from cholangitis can feel a lot like the pain from gallstones.

To be sure you have cholangitis, your healthcare provider will look at your past health and give you a physical exam. He or she may also use other tests.

You may have blood tests including:

• Complete blood count (CBC). This test measures your white blood cell count. You may have a high white blood cell count if you have an infection.
• Liver function tests. A group of special blood tests that can tell if your liver is working properly.
• Blood cultures. Tests to see if you have a blood infection.

You may also have imaging tests including:

• Ultrasound (also called sonography). This test creates images of your internal organs on a computer screen using high-frequency sound waves. It is used to see organs in your belly such as the liver, spleen, and gallbladder. It also checks blood flow through different vessels. It can be done outside the body (external). Or it may be done inside the body (internal). If internal, it is called an endoscopic ultrasound (EUS).
• CT scan. A CT scan may be done with a dye that is swallowed or injected through an IV. This will show the abdomen and pelvis including the bile drainage area. It can help determine why there is a blockage.
• Magnetic resonance cholangiopancreatography (MRCP). This test is used to look for any problems in your abdomen. It can show if there are gallstones in your bile duct. The test is done from outside your body. It does not involve putting a tube (endoscope) into your body. It uses a magnetic field and radio frequency to make detailed pictures.
• ERCP (endoscopic retrograde cholangiopancreatography). This is used to find and treat problems in your liver, gallbladder, bile ducts, and pancreas. It uses X-ray and a long flexible tube with a light and camera at one end (an endoscope). The tube is put into your mouth and throat. It goes down your food pipe (esophagus), through your stomach, and into the first part of your small intestine (the duodenum). A dye is put into your bile ducts through the tube. The dye lets the bile ducts be seen clearly on X-rays. If required, this procedure can also help open up your bile ducts.
• Percutaneous transhepatic cholangiography (PTC). A needle is put through your skin and into your liver. Dye is put into your bile duct so that it can be seen clearly on X-rays. This procedure can also be used to open up the bile ducts if your physicians are unable to do it internally with an ERCP. 

   

How is cholangitis treated?

It is important to get a diagnosis right away. Most people with cholangitis feel very sick. They see their healthcare provider or go to the emergency room.

If you have cholangitis, you will likely be in the hospital for a few days. You will be given fluids by IV (intravenous) line through a vein. You will also have pain medicine and bacteria-fighting medicine (antibiotics).

You may also need to drain the fluid in your bile duct and find the cause of any blockage. In most cases, this is done by a method called ERCP (endoscopic retrograde cholangiopancreatography).

To drain your bile duct using ERCP, a long thin flexible tube (endoscope) is put in your mouth. The scope goes down your food pipe (esophagus) and into your stomach. It passes into the first part of your small intestine (the duodenum) and into the bile ducts. The doctor can see the inside of these organs and ducts on a video screen. The video screen is connected to a camera in the scope. Sometimes a tube is left to the outside to drain bile. In this situation, a small tube is passed into the ducts to drain fluid. This tube is brought out through the skin, where it lets fluid drain out until the infection and inflammation clear up.

You may also have firm tubes (stents) put into the bile ducts to keep them open. Gallstones can also be removed. In most cases these things can be done using the ERCP scope.

You may need surgery if treatment doesn’t work or if you are getting worse. Surgery will open your ducts to drain the bile and reduce the buildup of fluid.

Key points

• Cholangitis is inflammation of the bile duct system.
• The bile duct system carries bile from the liver and gallbladder to the first part of your small intestine (the duodenum).
• In most cases cholangitis is caused by a bacterial infection.
• People who have had gallstones are at greater risk for cholangitis.
• Autoimmune diseases like primary sclerosing cholangitis can cause inflammation of the bile ducts.
• In most cases, hospitalization and treatment with antibiotics and an endoscopic procedure are necessary. Surgery may be required.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Bile Duct Cancer Symptoms | Bile Duct Cancer Signs

Bile duct cancer
does not usually cause signs or symptoms until later in the course of the disease, but sometimes symptoms can appear sooner and lead to an early diagnosis. If the cancer is diagnosed at an early stage,
treatment might work better.

When bile duct cancer does cause symptoms, it’s usually because a bile duct is blocked. Symptoms tend to depend on whether the cancer is in ducts inside the liver (intrahepatic) or in ducts outside the liver (extrahepatic), and include:

Jaundice

Normally, bile is made by the liver and released into the intestine. Jaundice occurs when the liver can’t get rid of bile, which contains a greenish-yellow chemical called bilirubin. As a result, bilirubin backs up into the bloodstream and settles in different parts of the body. Jaundice can often be seen as a yellowing of the skin and in the white part of the eyes.

Jaundice is the most common symptom of bile duct cancer, but most of the time, jaundice isn’t caused by cancer. It’s more often caused by hepatitis (inflammation of the liver) or a gallstone that has traveled to the bile duct. But whenever jaundice occurs, a doctor should be seen right away.

Itching

Excess bilirubin in the skin can also cause itching. Most people with bile duct cancer notice itching.

Light-colored/greasy stools

Bilirubin contributes to the brown color of bowel movements, so if it doesn’t reach the intestines, the color of a person’s stool might be lighter.

If the cancer blocks the release of bile and pancreatic juices into the intestine, a person might not be able to digest fatty foods. The undigested fat can also cause stools to be unusually pale. They might also be bulky, greasy, and float in the toilet.

Dark urine

When bilirubin levels in the blood get high, it can also come out in the urine and turn it dark.

Abdominal (belly) pain

Early bile duct cancers seldom cause pain, but bigger tumors may cause belly pain, especially below the ribs on the right side.

Loss of appetite/weight loss

People with bile duct cancer may not feel hungry and may lose weight without trying to do so.

Fever

Some people with bile duct cancer develop fevers.

Nausea and vomiting

These are not common symptoms of bile duct cancer, but they may occur in people who develop an infection (cholangitis) as a result of bile duct blockage. These symptoms are often seen along with a fever.

Keep in mind: Bile duct cancer is rare. These symptoms are far more likely to be caused by something other than bile duct cancer. For example, people with gallstones have many of these same symptoms. And there are many far more common causes of belly pain than bile duct cancer. Also, hepatitis (an inflamed liver most often caused by infection with a virus) is a much more common cause of jaundice.

Still, if you have any of these problems, it’s important to see a doctor right away so the cause can be found and treated, if needed.

Bile Duct Leaks | Michigan Medicine

A small hole anywhere along the bile ducts can cause bile to leak into the abdominal cavity. A bile duct leak can arise either as a complication of a surgery, such as gallbladder removal or liver transplant, or from trauma to the biliary system.  At the Bile Duct and Pancreatic Diseases Program, part of the University of Michigan’s Division of Gastroenterology, our multidisciplinary team provides the newest minimally invasive treatments for bile duct leaks. These treatments are not widely available, and are performed by experienced gastroenterologists with high volumes in these procedures. 

Bile is a digestive fluid produced by the liver and stored in the gallbladder, and is used by the body to break down fats so they can be absorbed. The biliary system—which includes the gallbladder and bile ducts—produces and transports bile into the duodenum (the first part of the small intestine) to aid in digestion. A bile duct leak can cause pain, inflammation and infection in the abdominal cavity where the bile has leaked. 

Bile Duct Leak Symptoms 

• Severe abdominal pain
• Nausea
• Vomiting
• Fever
• Jaundice 

Diagnosing a Bile Duct Leak 

To diagnose a bile duct leak, we begin with a comprehensive exam and collecting a thorough history. Blood work is typically ordered to look at issues including elevated liver enzymes. 

A biliary study called a hepatobiliary (HIDA) scan may be ordered. A HIDA scan shows the flow of bile from the liver to the small intestine. To perform this test, a radioactive tracer is injected into a vein in the arm and then a special camera takes pictures of the tracer as it moves through the bile ducts. 

A leak can also be diagnosed by using a needle to remove a small amount of abdominal fluid. If the fluid contains bile, then a bile duct leak is confirmed. 

Treating Leaks in the Biliary System 

Our standard treatment for a bile duct leak is an endoscopic retrograde cholangiopancreatography (ERCP) with placement of a temporary bile duct stent (which looks like a plastic straw).

An endoscopic retrograde cholangiopancreatography is a minimally invasive procedure that combines x-ray and upper endoscopy—an exam of the upper gastrointestinal tract, consisting of the esophagus, stomach, and duodenum (the first part of the small intestine)—using an endoscope, which is a lighted, flexible tube, about the thickness of a finger. The doctor passes the tube through the mouth and into the stomach, then injects a contrast dye into the ducts to view the bile ducts, which can be seen on x-ray. Special tools can be guided through the endoscope to insert a stent to stop the leak.

Patients can typically go home same day, once their sedation wears off.

Other Information About Digestive and Liver Health

Make an Appointment

To schedule an appointment to discuss your need for bile duct stone treatment, call us at 888-229-7408.

Gallbladder Surgery Long-Term Care

Gallbladder surgery can be successful in treating gallstones, but a significant number of people have adverse symptoms known as post-cholecystectomy syndrome. Adjustments to your diet and eating habits may help relieve these problems. In some cases, a second surgery may be needed to resolve these symptoms. As well, people who have gallbladder surgery to address cancer also have differences in outcomes.

Moyo Studio/Getty Images

Benefits of Surgery

The number one reason for gallbladder surgery—gallstones—results in one of the most commonly performed elective abdominal surgeries, worldwide, namely, laparoscopic cholecystectomy (LC).  A cholecystectomy is the removal of the gallbladder. In fact, there are 700,000 laparoscopic cholecystectomies in the U.S. each year.

A 2019 systematic review found that over half (60%) of the people who had their gallbladder removed did not experience any adverse symptoms after surgery and went on to live a normal, healthy life. The pain caused by gallstones completely subsided in this population.

Many of those who experience negative symptoms such as indigestion and diarrhea after gallbladder surgery are able to get relief by simply changing their diet. The study authors point out that if you are having any discomfort or digestive problems after gallbladder surgery, it’s best to get treatment right away instead of waiting to see if the symptoms improve on their own.

Possible Future Surgeries

There are several common conditions and symptoms that can surface after a person has gallbladder surgery, and some may require a subsequent surgical procedure. Common conditions that may occur after a cholecystectomy include newly formed or residual gallstones.

Post-Cholecystectomy Syndrome

Having adverse symptoms after gallbladder surgery is referred to as post-cholecystectomy syndrome. Post-cholecystectomy syndrome is a loose term pertaining to adverse symptoms experienced after a gallbladder removal procedure. Post-cholecystectomy syndrome includes symptoms of:

• Fatty food intolerance
• Nausea
• Vomiting
• Flatulence (gas)
• Indigestion
• Diarrhea
• Jaundice (yellowish tinge to the skin and whites of the eyes)
• Episodes of abdominal pain

According to a 2018 study, having a cholecystectomy did not relieve a person’s symptoms in as many as 40% of those who had the surgery. This translates to nearly 280,000 people (out of a total of 700,000) each year who do not experience a complete absence of symptoms after gallbladder surgery.

A systematic review of those with long-term post-cholecystectomy syndrome was conducted to guide providing treatment for this population. In this study, gallstones that did not get removed the first time a cholecystectomy was performed (as well as new gallstones that formed after the initial gallbladder surgery) accounted for up to 23% of post-cholecystectomy symptoms.

Many people who experience post-cholecystectomy symptoms caused by residual gallstones must undergo a second surgical procedure to remove the gallstones that were left behind. Residual gallstones are commonly found in the common bile duct (CBD). 

Gallbladder Remnant

Sometimes a portion of the gallbladder is left behind during a cholecystectomy; this is called a gallbladder remnant. When a person has a gallbladder remnant, gallstones can continue to form in the gallbladder, requiring a subsequent surgical procedure to remove the remnant.

According to a 2018 study, incomplete removal of the gallbladder after an open or laparoscopic cholecystectomy is the most common reason for abdominal pain, indigestion, and jaundice after a gallbladder removal procedure.

Cystic Duct Stump

Another surgical procedure that is sometimes performed after a cholecystectomy is called an “excision of a cystic duct stump with stone.” But this condition is considered a rare cause for post-cholecystectomy syndrome. Once the gallbladder is removed, the cystic duct is no longer needed and it is usually detached at a point that is very close to where it joins the common bile duct.

Sometimes a very small portion of the cystic duct is left behind, this is referred to as a cystic duct stump. A cystic duct remnant is a term used when the size of the cystic duct following cholecystectomy is more than or equal to 1 centimeter (0.39 inches).

The cystic duct is approximately 1.5 inches long. It’s part of the biliary system that functions to allow bile to travel from the liver to the small intestine. The biliary system is a collection of tubular shaped structures called bile ducts. The bile ducts lead from the liver to the gallbladder, then empty into the small intestine (where bile works to help digest and absorb ingested fats).

Long-Term Outcome of Gallbladder Cancer

Another indication for gallbladder surgery is to remove a tumor. A 10-year study looked at the long-term results for people who had surgery for cancer of the gallbladder.

Some of the people who participated in the study were diagnosed with cancer before they underwent the first cholecystectomy, others were diagnosed intraoperatively (during the gallbladder surgery). Others yet were diagnosed after the tissue from the gallbladder (after the cholecystectomy) was sent to the pathology lab for examination.

The study authors discovered that the overall average survival rate differed, depending on when the cancer was diagnosed, for example:

• Of those in the study where the cancer was diagnosed intraoperatively (during the cholecystectomy) and the cancer was advanced and considered irresectable (unable to be removed by surgery), these study participants had an average survival rate of one month.
• Of the study participants who were diagnosed before they underwent cholecystectomy, none experienced curative operations. 
• Of those diagnosed incidentally (as a result of pathology examination of the gallbladder tissue), the average survival rate was 38 months. 
• Four of the study participants who were incidentally diagnosed underwent a surgical procedure called a radical re-section after their initial cholecystectomy. All four were considered curative.  

Note, those who had symptoms of jaundice (yellowish tinge to the skin and eyes) had worse outcomes in the study than those who had normal bilirubin levels.

Lifestyle Adjustments

After gallbladder surgery, long-term care is usually minimal; most people live a perfectly normal life without a gallbladder because the liver can still produce enough bile to breakdown ingested fats in the diet. The primary difference is that instead of simply getting a bolus of bile after a large meal is ingested, people who have undergone a cholecystectomy have a continuous drip of bile from the liver into the duodenum (the first part of the small intestine).

Although it has not been proven in clinical research studies, some experts point to the probability that this continuous flow of bile acids into the small intestine may be attributed to symptoms of dyspepsia (indigestion), may increase the risk of gastritis (inflammation of the stomach) and may cause duodenal (small intestine) gastric (stomach) reflux. Reflux occurs when the contents of the stomach or bile rise up and irritate the lining of the esophagus.

If you experience digestive problems such as bloating or diarrhea, these symptoms should not be long-term, but rather should subside within a few weeks after surgery.

Diet

After gallbladder surgery, it’s a good idea to keep a food journal or keep notes in a diet app, that way if a certain food or ingredient cause symptoms, you can take note of it and avoid that specific food in the future. After your gallbladder surgery, pay very close attention to how your digestive system responds to the foods you eat, foods that are commonly problematic include:

• Fatty or fried foods
• Spicy foods
• Acidic foods

Be sure to include in your journal how much of each food you eat, that way you can initially try reducing the amount of a problematic food, to see if eating less helps, before completely eliminating the food from your diet. Again, be aware that many of these food intolerances are temporary, so you can try to re-introduce problematic foods later on.

If you experience ongoing symptoms, it’s important to consult with your healthcare provider to be evaluated for any underlying physiological problems that could be causing adverse symptoms, including:

• Indigestion
• Bloating
• Flatulence (gas)
• Diarrhea

If you do experience adverse symptoms, diet interventions include:

• Avoid coffee, tea, and other caffeinated beverages
• Avoid any foods that worsen symptoms such as fatty or spicy foods
• Gradually increase the amount of fiber you eat (such as fruits, vegetables, and whole grains)

Diarrhea

A few people who have had gallbladder surgery experience persistent diarrhea. If you have diarrhea, you can ask your healthcare provider if there is a type of medication (over-the-counter or prescription) that is recommended.

A Word From Verywell

Although you may be under the impression that there are no long-term after-effects of gallbladder surgery, many people do experience some chronic problems; 40% of those observed in a 10-year follow up study did, in fact, have some residual effects.

Many times, residual symptoms of a cholecystectomy, do not require a person to have an additional surgical procedure. Rather, a lifestyle change (such as a simple change in diet) could be all that is needed. If you are experiencing symptoms after your gallbladder surgery, be sure to consult with your healthcare provider; it’s important to rule out any serious underlying causes, in addition to adjusting your diet.  

What to Do About IBS After Gallbladder Removal

Some people who have had their gallbladders removed—a procedure known as a cholecystectomy—find themselves dealing with ongoing digestive problems. Typically, these symptoms include abdominal pain or the urgent need to run to the bathroom after eating. Here you will find out why that might be happening and what you can do about it.

Verywell / Cindy Chung

Life With and Without a Gallbladder

It is safe to live without a gallbladder, which is one of the reasons gallbladder removal is typically the recommended treatment for gallbladder problems. Your gallbladder’s main job is to store bile (a substance needed for digesting fats) and to secrete bile into your small intestine in response to ingesting foods containing fat.

Without your gallbladder, your liver continues to produce bile, but instead of it being sent to the gallbladder for storage, the bile passes into your common bile duct and then makes its way into your small intestine.

Complications of Gallbladder Removal

Most of the time, the body adapts to the loss of the gallbladder. However, there are a few possible problems that people may experience following gallbladder removal.

Postcholecystectomy Diarrhea

Approximately 25% of people who have had their gallbladders removed will experience recurrent problems with diarrhea, a condition known as postcholecystectomy diarrhea.

This problem results from the fact that without the gallbladder, there is nothing to regulate the amount of bile that passes into the small intestine. The resulting higher amount of bile can create stools that are watery and more frequent. Luckily, for most of these individuals, this problem will resolve itself slowly over time.

Sphincter of Oddi Dysfunction

If you are experiencing ongoing upper abdominal pain following gallbladder removal, you may want to speak with your doctor about a possible problem with your sphincter of Oddi (SO).

The sphincter of Oddi is a valve found within the small intestine that regulates the flow of bile and pancreatic juices. A very small number of people may experience sphincter of Oddi dysfunction (SOD), a functional gastrointestinal disorder (FGD). In SOD, the sphincter does not relax as it should, preventing the bile and pancreatic juices from entering the small intestine.

SOD is characterized by pain in the central and upper right regions of the abdomen that lasts for at least 30 minutes and radiates to the back or shoulder.

This type of pain generally occurs a short time after eating. Some people report nausea and vomiting. The pain symptoms of SOD are thought to be the result of the excess accumulation of the juices in the ducts.

SOD is most often seen in postcholecystectomy patients or in those who have pancreatitis. It’s hard to gauge SOD’s actual prevalence after gallbladder removal as studies report prevalences ranging from just 3% up to 40%. SOD can be treated with medication or a procedure known as endoscopic retrograde cholangiopancreatography (ERCP).

IBS Following Gallbladder Removal

Although, anecdotally, numerous people with IBS report that their IBS began following removal of their gallbladder, there is not a lot of clinical research on the subject. However, researchers have begun looking into a condition called bile acid malabsorption (BAM) and its relationship to chronic diarrhea difficulties.

People who have had their gallbladders removed may be at risk for BAM, a condition in which there is dysfunction with the way that bile acids are processed within the body. Research on this topic is still light, so it’s best to work with your doctor to diagnose and resolve this issue.

An accurate diagnosis is necessary so you can get the right treatment plan. The American College of Gastroenterology (ACG) warns that testing for BAM is limited in the United States, and testing is not completely validated. In some cases, ongoing diarrhea following gallbladder removal may be helped by a class of medications known as bile acid-binding agents (aka. “bile acid sequestrants”), including:

The ACG does not currently recommend use of these drugs for diarrhea-predominant irritable bowel syndrome (IBS-D), citing a lack of studies. Still, the experts at ACG realize that these medications may be helpful in some cases, advising their use should be left to the discretion of the patient’s medical provider.

When to See Your Doctor

If you are experiencing ongoing problems with abdominal pain and/or diarrhea, you should work with your doctor to get an accurate diagnosis. The range of possibilities for your ongoing problems is fairly varied:

• Common bile duct stones
• Chronic pancreatitis
• Dyspepsia
• IBS
• Pancreatic cancer
• SOD

If you are experiencing fever, chills, or signs of dehydration, you should contact your physician immediately.

Managing Symptoms With Diet

Without your gallbladder participating in the process of digestion, you may need to change your eating habits. If your gallbladder was only removed very recently, you may want to eat a bland diet until your diarrhea symptoms start to ease.

The gallbladder’s job is to help you digest fatty food, so having it removed can make these foods problematic for you. Once you’re back on a “regular” diet after surgery, you may want to limit or avoid:

• Fried foods: French fries, onion rings, mozzarella sticks
• High-fat foods: Fatty meats, cheese, ice cream, butter, gravy, chicken skin, pizza, oils
• Foods that cause gas: Beans, broccoli, milk
• Spicy foods: Curry, hot sauce, hot peppers

Gradually re-introducing potentially problematic foods into your diet can help you learn what bothers you without creating too much discomfort.

Although there isn’t necessarily hard science behind these recommendations, you might find the following tips to be helpful:

Remember, although coping with symptoms is no fun, there are a few factors (such as your diet) that are in your control.

Frequently Asked Questions

How do digestive enzymes help with IBS symptoms after gallbladder removal?

Digestive enzymes are supplements that help break down the food you eat to make absorption easier, which may also help with some common IBS symptoms like diarrhea.

How do probiotics help with IBS symptoms after gallbladder removal?

Probiotics can help healthy gut bacteria maintain appropriate levels and aid in digestion. Some research also notes that probiotics may help lower cholesterol, which is helpful for people who no longer have gallbladders.

90,000 Complications after removal of the gallbladder

Optimal method of treatment of gallstone disease

Today, the gold standard is laparoscopic cholecystectomy. It is performed through three or four small incisions (punctures) using a special video camera and tools. There is an option of execution through one slightly larger incision in the navel area, without an incision at all (through the stomach), and even with the help of a robot, but they have not received widespread acceptance (the advantages are not obvious, but the cost is higher).

In the overwhelming majority of cases, the period of stay in the clinic is two days: hospitalization on the day of surgery, discharge the next day after control of analyzes, ultrasound. Of course, the decision to discharge is always joint, if the patient is calmer for a longer time under supervision, we will always support.

For a week after the operation, we usually recommend a sparing regimen, although you are feeling quite well. The first two or three days may be disturbed by aching pain in the shoulder, this is associated with residual gas in the abdominal cavity and occurs after any laparoscopic operation.

Diet after cholecystectomy

The question is very controversial, in fact. In my opinion, the rumors about the need for a strict diet are greatly exaggerated.

There is no reservoir function of the gallbladder, bile in its original form constantly enters the duodenum. In this regard, it is necessary to eat more often (it comes in constantly), in small portions and to limit fats (the bile in the duodenum at every moment of time should be “enough” for the emulsification of fats).If you break the diet, nothing particularly bad will happen, but the patient will understand this (it will hurt, and diarrhea).

About complications of cholecystectomy

All complications can be divided into two types: arising directly during or in the near future after the operation; and distant (notorious postcholecystectomy syndrome).

Most of the complications arising during or immediately after the operation, fortunately, are “small” and do not threaten life and health.These are hematomas, seromas, inflammation – in total in the region of 5%, most often they do not require any special treatment, not to mention repeated operations.

There are, by and large, four serious complications during surgery – bleeding, trauma to the bile ducts, pulmonary embolism and residual choledocholithiasis.

Despite the proven technique of laparoscopic cholecystectomy, it has not yet been possible to completely exclude them even in clinics where a great deal of experience has been accumulated in performing these operations.

Bleeding

It is clear with bleeding – it can occur during any operation. With elective cholecystectomy, the risk is minimal.

Damage to the bile ducts

A terrible dream for any surgeon. According to the literature, the frequency is 0.15–0.36% and depends on many factors: planned or emergency surgery (it is clear that the planned risks are much lower), the severity of inflammatory and cicatricial changes in the gallbladder area, constitutional and anatomical features… There are a number of anomalies (the relationship of anatomical structures in the gallbladder area), which sometimes baffle even a very sophisticated surgeon. The basic rule here is “not sure – do not overtake”, in the sense that we must be absolutely confident in understanding the anatomy of a particular patient. Always. Every time. Even in the most “banal” cases.

Of course, the experience of the surgeon and the quality of the equipment are of great importance. There are a number of techniques that allow you to minimize the risk of complications – the critical view of safety technique (for me and for many colleagues, it is mandatory during every operation), intraoperative cholangiography, and even the use of fluorescent laparoscopy (ICG).I think the technical features are not very interesting for “non-surgeons”, but nevertheless)

The next complication is pulmonary embolism

Fortunately, it is quite rare with laparoscopic cholecystectomy and proper prophylaxis, although it is still impossible to prevent it by 100%. A lot of factors affect, including the time of surgery, the amount of blood loss, the state of the coagulation system, the presence of varicose veins, age … All this is taken into account, the risks and the selection of the optimal prevention option are determined.

“Forgotten” stones in the bile duct or residual choledocholithiasis

A separate large topic of conversation such as “If the gallbladder is removed, stones will continue to form in the ducts.” Many times have already written – this is a very rare story, except in a situation such as persistent cholangitis or cystic fibrosis. The vast majority of stones in the ducts after removal of the gallbladder were there at the time of removal, but did not manifest themselves in any way. Until recently, we had no safe way to diagnose asymptomatic choledocholithiasis.In recent years, we have been actively using MRI (it is safe and informative). I think this will greatly reduce the number of “forgotten stones”.

Long-term consequences of gallbladder removal or postcholecystectomy syndrome (PCES)

I must say that there are quite a few myths and horror stories about this. I will try to express my point of view based on my own experience and analysis of world literature.

As the name suggests, postcholecystectomy syndrome refers to any problems with the gastrointestinal tract after removal of the gallbladder.

Let me remind you that “after” does not always mean “due to”. In most cases, these problems have nothing to do with the operation itself; often, upon careful analysis, it turns out that the patient had them before the operation. This once again emphasizes the need for a careful assessment of the clinical picture and an individual approach when deciding whether to remove the gallbladder. In my opinion, it is precisely the insufficiently careful assessment of the symptoms and the desire to remove the gallbladder at all costs that leads to the appearance of most comments like “They removed it – it only got worse”, etc.

Most often, for the so-called. “PCES” accept irritable bowel syndrome, gastroesophageal reflux disease, peptic ulcer disease and chronic pancreatitis. Muscle or neurogenic pains cannot be written off either. Why are they diagnosed with PCES? Doctors are people too, and people tend to follow the path of least resistance .. “Does it hurt? Was the bile removed? Of course, this is PCES! ” Revealing the true cause is not so easy, in fact.

If we do not take into account the previously described complications during the operation, two problems can be attributed to the real long-term consequences of cholecystectomy: postoperative diarrhea and dysfunction of the sphincter of Oddi.

Postoperative diarrhea

Opinions about the reasons for its appearance are different, most experts assign the leading role to the lack of reservoir function of the gallbladder. With insufficient reabsorption of the constantly flowing bile, it enters the large intestine in larger than usual quantities, which provokes diarrhea. I must say that with gallstone disease, the function of the bladder is already impaired, and some patients complain of diarrhea even before the operation.

Very different data on the frequency of this symptom, from 1 to 35%.Most studies say 10-15%. In my practice, it is much lower, but the reliability of personal observations, as you know, is low. In addition to adhering to a diet (it is very important to eat a little several times a day), bile acid sequestrants (cholestyramine) will help to cope with diarrhea, sometimes you have to prescribe loperamide. In the vast majority of cases, diarrhea goes away rather quickly.

There is an opinion, confirmed by experimental studies, that with the preserved sphincter apparatus, the common bile duct partially compensates for the reservoir function of the gallbladder for several months.

Dysfunction of the sphincter of Oddi or DSO

It manifests itself in episodes of rather intense pain in the right hypochondrium, reminiscent of pain in biliary colic. The reason is the spasm of the sphincter of Oddi (it regulates the flow of bile from the common bile duct into the duodenum).

DSO is of two types:

• Type 1 – pain in the right hypochondrium with dilated bile ducts and elevated transaminases (ALT and AST).
• Type 2 – pain is accompanied by one thing: either dilated ducts or elevated transaminases.

Type 1 is very effectively treated with papillotomy (incision of the large duodenal nipple)

The effectiveness of papillotomy in type 2 DSO is much lower (about 40%), but still enough for this procedure to be very carefully considered.

Summing up, I want to emphasize once again the importance of a balanced, individual approach to such a “banal” operation as cholecystectomy. Have biliary colic or acute cholecystitis? Of course, it is necessary to operate, the likelihood of further serious problems is much higher than complications.

“Accidentally” found stones in the gallbladder and there are no symptoms? Live in peace with your diet. Symptoms will appear – come without waiting for complications, we will help!

Postcholecystectomy syndrome

[Radio Liberty: Programs: Science and Medicine]

[24-12-05]

Postcholecystectomy syndrome

Host Olga Beklemishcheva: Today we are talking about postcholecystectomy syndrome.This is a syndrome that develops in patients after surgery to remove the gallbladder. In Russia, about a quarter of a million operations are performed annually to remove the gallbladder, and 2-5 percent of patients develop this syndrome after the operation. The Internet is full of advertisements for the aftercare of such patients in a sanatorium, which, as our today’s guests will tell us, is completely wrong, and even dangerous. Therefore, I urge our listeners (and especially listeners, because this disease is more common among the beautiful half of humanity) to listen carefully to our guests.And I present them to you – this is the head of the department of hospital surgery number 2 of the Russian State Medical University, located on the basis of the 31st clinical hospital in Moscow, Professor Sergei Georgievich Shapovalyants and associate professor of this department, surgeon Alexander Alekseevich Lindenberg. As always, our American expert, Professor Daniil Borisovich Golubev, will take part in our conversation. Sergey Georgievich, what is the prevalence of biliary tract disease in the population? And how many people with such a pathology are likely to end up under the surgeon’s knife? Sergey Shapovalyants: It is not for nothing that this disease is called “the disease of the century”, one of the diseases of our time.Approximately 8 to 15 percent of patients over 50 years of age, predominantly female, suffer from cholelithiasis. It cannot be said that it manifests itself brightly in everyone and is a reason for surgical intervention. But according to various statistics, about a quarter of these patients require surgical treatment, as these stones manifest themselves. And so far nothing has offered any other methods of treating this disease … effective, reliable, with a stable long-term result. Olga Beklemishcheva: Alexander Alekseevich, I want to ask you a question. The fact is that in a number of cases people still hope that the operation will not take place. But now they are already diagnosed with calculous cholecystitis. What does it mean? Is surgery always necessary? Or can you somehow pull, wait? Alexander Lindenberg: It must be said that if the diagnosis has already been established, then a certain clinical picture in the form of pain is present in this person.And since she is present and the diagnosis has been made, then, unfortunately, he has one way – to the surgical clinic for surgical treatment. Olga Beklemishcheva: And as soon as possible? Alexander Lindenberg: Not only as soon as possible, but also preferably on a planned basis. Because I would like to emphasize the fact that it is the emergency operation for cholecystitis in people with advanced forms of this disease that gives the greatest number of postcholecystectomy syndrome, which we will now talk about. Olga Beklemishcheva: And now I want to ask our American expert. Daniil Borisovich, how many Americans live without a gallbladder? Daniil Golubev: Judge for yourself: every year in America, about half a million operations are performed to remove the gallbladder, mainly due to cholelithiasis and cancers. Especially often these operations began to be performed with the introduction of laparoscopic techniques. So more than a million people live without a gallbladder. Olga Beklemishcheva: And how do they feel? Daniil Golubev: In 80, even in 90 percent of cases, removal of the gallbladder – both by “open” surgery and by laparoscopy – proceeds without complications. Nevertheless, in people with a removed gallbladder during the first months (or even years) after the operation, the so-called “dumping syndrome” is often observed, which sometimes drags on, darkening the patient’s life with dyspepsia, flatulence, and diarrhea.The leading treatment for this syndrome in American medicine is diet therapy and detoxification with special nutritional supplements. Of the drugs, Cholestyramine is widely used (other names for this drug are Questran or Prevalit). It is also used to lower cholesterol levels. The most serious complication after removal of the gallbladder is considered to be damage to the common bile duct, and it is relatively more common with laparoscopy than with “open” surgery.In general, one can live without a gallbladder, as well as without a spleen, strictly speaking. Among the many pseudonyms of early Chekhov was not only “Antosha Chekhonte”, but also such – “A man without a spleen.” At the time of Doctor Chekhov, there were only a few such people, but now there are hundreds of thousands of them. Olga Beklemishcheva: Thank you, Daniil Borisovich. Professor Shapovalyants, I know that you are the most famous specialist in laparoscopic techniques in Moscow. And Aleksandr Alekseevich operates more in an “open way”.Professor Golubev said that after all, there are slightly more complications with laparoscopy than with the open method. The advantages of laparoscopy are clear – less traumatism, better cosmetic effect, and in general everything goes easier. But how is the choice for a particular patient about how the stone will be removed – laparoscopically or “open”? Sergey Shapovalyants: The priority, of course, is the laparoscopic method of removal due to its low trauma, good cosmetic effect, calm postoperative period.The point is that when the laparoscopic technique is used – and sometimes unexpectedly complex technical circumstances are encountered, it is here that the experience of the surgeon manifests itself, who understands that the capabilities of the laparoscopic technology in this patient have been exhausted, and it is necessary to move in the interests of the patient’s safety to traditional surgical intervention … When sometimes they try at all costs to complete the operation laparoscopically, as a rule, it is these circumstances that predispose to injury to vital anatomical structures, primarily the biliary tract.Although not a single surgeon is immune from this, either in “open” or in laparoscopic surgery. To put in a straight line, so to speak, the dependence of the probability of injury to the ducts and the choice of the method of operation is incorrect. Of course, the priority is, as it is called in the literature, the “gold standard” – the laparoscopic method of operating. But I return to the idea that there may be approximately 5-8 percent of patients who make up a group where it is already clear before the operation that this operation should be done in an “open”, traditional way.Or, during the operation, circumstances arise that lead to the so-called conversion, that is, the transition from the laparoscopic method to the traditional one is carried out. It is important to correctly assess this moment and take this step in time. Olga Beklemishcheva: I would like to clarify. Are we talking about planned patients? That is, if a person entered the emergency service, then, most likely, he will be operated “openly”? Sergey Shapovalyants: No.Now there are a number of techniques for acute cholecystitis. And in both elective and emergency surgery, the majority of operations are performed laparoscopically. But, of course, the proportion of patients who undergo traditional operations for acute cholecystitis (that is, those who come “by ambulance”), it is higher. Olga Beklemishcheva: And we finally come to the main topic of our program. The operation took place. What’s next? How should a person behave after surgery in order to quickly get through this unpleasant episode in his life? What should he do? And when does this complication arise – postcholecystectomy syndrome? Alexander Alekseevich, please. Alexander Lindenberg: If we talk about the bulk of patients operated on for gallstone disease and underwent some form of cholecystectomy, the beauty is that in three to four months these are people who should lead an absolutely normal lifestyle. Olga Beklemishcheva: So this does not mean that they are doomed to diet number 5 for the rest of their lives? Alexander Lindenberg: By no means.For this, people go to the operating table in order to subsequently lead, I repeat, a normal way of life, including the dietary regimen. That is, they are no different from people with a gallbladder. The body needs three to four months to adapt to the absence of a gallbladder. But it so happens that the patient formally lives with a bladder, because the bladder has not been functioning for a long time. And therefore, whether he has it or not, it no longer matters. Only there is still some danger of a serious illness.And, in fact, we do not give other recommendations. Regimen and diet for a very short period of time. Olga Beklemishcheva: Professor Shapovalyants, how then do these people who suffer from postcholecystectomy syndrome appear? Is it a violation of the technique of the operation, is it a violation of the food regimen after the operation? Sergey Shapovalyants: It should be clearly understood that there are groups of patients, the first of which the respected expert spoke about, these are patients who had unforeseen circumstances during the operation, which led to a violation of the integrity and normal anatomical relationships in the structure of the biliary tract …Simply put, wound, trauma, crossing. Now, in connection with laparoscopic technology, electrical injuries of the bile duct have also been added. And here one scenario, which begins immediately after the operation, requires special methods to clarify the nature of the injury. In most cases, this is already established during the operation and is subject to correction. This group of people, it makes up about 4-8 percent of the total number of patients with postcholecystectomy syndrome. Some call it “true postcholecystectomy syndrome.”Another group of patients is patients who, in addition to calculous cholecystitis, often have other diseases before the operation. They, perhaps, are not sufficiently taken into account before the surgical intervention, and their role in the clinical course – pain syndrome, dyspeptic syndrome, as it turns out after the operation, were caused not so much by calculous cholecystitis as by other sufferings in the form of diseases of nearby structures – this is the liver, duodenum , the right kidney, and sometimes other anatomical structures.And then they come to the fore. Olga Beklemishcheva: That is, in fact, when they saw stones in the gallbladder, they focused all their attention on them, and under-examined the patient, right? Sergey Shapovalyants: Quite right. It seems to lie on the surface. This is the first finding, it is associated with pain in the right hypochondrium, although there may be various options and nuances that need to be clarified at the clinical level, first of all, the clinical course of the disease, an attentive conversation with the patient, and here reasoning before the operation of a completely different property is possible. Olga Beklemishcheva: And what then needs to be done before the operation, what examinations should be done before the operation, in order to be sure that gallstone disease plays the leading role in the disease? Sergey Shapovalyants: I am returning to the fact that, first of all, this is the clinical course of the disease, and this is a very detailed and attentive conversation with the patient. He will tell you everything. Olga Beklemishcheva: Let’s try to explain it easier for our listeners.So I came and complain of pain in the right hypochondrium. What do you ask me? What do I need to pay attention to besides this? Sergey Shapovalyants: You know, the symptomatology of, say, duodenal ulcer has its own features. If this is the suffering of the liver, then they are also slightly different. If this is the right kidney or, say, suffering associated with radicular syndrome, and maybe the help of a neurologist will be needed here. In short, a whole list of diseases that can cause more suffering, and sometimes only they cause suffering to the patient.And calculous cholecystitis is in the form of a kind of stone carriage, and is a find that is interpreted as the main cause of the disease, and leads to the removal of the gallbladder. I would also like to add that a very important group is the suffering of patients associated with the fact that calculi, that is, gallstones, they appear not only in the gallbladder, but also in the bile ducts. This does not always show up clinically. And after removal of the gallbladder, this symptomatology comes to the fore.And it turns out that the extrahepatic bile ducts have not been fully examined before the operation. And especially the place where the bile ducts enter the duodenum. It can be obscured, ignored, and not subject to correction during surgery or prior to surgery. And, unfortunately, these sufferings, they come to the fore and do not allow patients to feel healthy. Olga Beklemishcheva: Thank you, Sergey Georgievich. Alexander Alekseevich, what needs to be done to still reveal these stones in small ducts? Maybe an ultrasound scan? Alexander Lindenberg: Ultrasound – yes, of course.This method is simple, convenient and affordable. But in some situations, especially if we still see a change in the analyzes, which indicate that a condition is observed in the liver, which is called cholestasis, that is, translating into Russian, stagnation of bile, say, there is some kind of obstacle to its normal physiological outflow, then we also use methods of various kinds of contrasting. Previously, these were mainly methods of indirect contrast, that is, this is what we called cholangiography.Even in ancient times, about 30 years ago, these were the famous pills that drank 12 pieces each, and watched how and what was painted. Now we mostly try to use more modern methods. There are two of them. Let’s say there is a brilliant method on the basis of our hospital. This is a method that allows endoscopic examination of the ducts directly. Endo-ultrasound is called. That is, the ultrasound probe is brought directly to the duct. Olga Beklemishcheva: And how? Alexander Lindenberg: Through an endoscope, through a flexible technique. Olga Beklemishcheva: With a minimal cut, right? Alexander Lindenberg: There is no cut. The person swallows it. And the more famous and more widespread are direct contrasting methods. In particular, retrograde cholangiopancreatography. Why this method is good. It allows you to visually assess, that is, by eye, what is happening in the stomach, in the duodenum, and to reveal, for example, an ulcer, which can also proceed under the guise of acute cholecystitis or chronic cholecystitis.Plus, this is complete information about the duct system down to the smallest nuances and details. The method is quite effective, it is widely used in our country and gives very good results. Olga Beklemishcheva: You know, I met on the website of one of the Moscow clinics such a recommendation that this retrograde cholangiopancreatography should be performed without fail for all patients with suspected calculous cholecystitis. What is your opinion, Sergei Georgievich? Sergey Shapovalyants: Here Alexander Alekseevich said that the method is very highly informative.But, unfortunately, one of its drawbacks is that this information comes at a rather high price. Often after this intervention – such an injection of a contrast agent into the bile ducts and partly into the pancreatic ducts – it can cause some complications that arise, depending on the experience of the researcher, in about 10-20 percent of observations. Often these are serious complications in the form of an exacerbation of pancreatitis, in the form of inflammatory changes in the bile ducts, which require rather vigorous therapeutic measures. Olga Beklemishcheva: But in general, probably, it’s always a whole complex. If there are stones in the liver, then, probably, there is some kind of inflammation in the duodenum and in the pancreas, gastritis. Sergey Shapovalyants: Yes, there is a complex, starting with clinical manifestations of biochemical indicators, that is, the level of bilirubin, a number of enzyme indicators. And the indicators of conventional, traditional ultrasound examination are very important. This combination allows you to either calm down and consider that the removal of the gallbladder will be the final method of treating the patient, or, conversely, to be wary, to say that “yes, this patient should not be subjected to cholecystectomy just like that.We must continue this examination. It is desirable to achieve a complete understanding of the state of the extrahepatic bile ducts. “ Olga Beklemishcheva: In general, what can be the reason that calculous cholecystitis does not manifest itself, but in fact other diseases contribute more to the clinic? ? Why can it happen that the stones seem to be there, but the organ itself does not suffer, and the person, in fact, is ill with something else? Sergey Shapovalyants: You know, our once famous morphologists, for example, Ippolit Vasilievich Davydovsky, pointing to the results of autopsies of patients who died from completely different diseases, named a figure of approximately 13-15 percent, where stones in the gallbladder were found that did not manifest themselves in any way during life.I repeat that the patients felt completely safe and died from other causes. And here, of course, the size of the stone, their location, the configuration of these stones … But I can say that there are some complications for large stones. As a rule, this is a possible bedsore in the wall of the gallbladder, exacerbation of acute cholecystitis. If these are small stones, then their movement into the main bile ducts is possible, with all the ensuing consequences – with blockage, with the development of jaundice, with the development of pancreatitis – this is a very serious suffering that complicates gallstone disease.This is the kind of dependence – in general, it is, in fact, the will of chance. You see, there is a predisposition to such a clear clinical manifestation, but there is a milder course, which is designated as stone carriage, asymptomatic gallbladder stones. But knowing the insidiousness of the course of this disease, as a rule, the revealed stones with the obligatory detailed further examination of the patient are an indication for surgery. Olga Beklemishcheva: Tell me, since women are more likely to suffer from calculous cholecystitis and are more likely to undergo surgery, autopsies of those with asymptomatic stones, who were more, do you know, men or women? Sergei Shapovalyants: You know, I think there are women, of course.There are quite a few theories, so to speak, of a woman’s belonging to the disease of cholelithiasis. These are hormonal prerequisites … In short, we know that there are diseases that are more typical for women – and this is gallstone disease, or more for men – this is, for example, a peptic ulcer, women are less likely to suffer from this disease. Therefore, when a patient comes with pain in the right hypochondrium, looking at him – at his age, at his complexion, gender, it is already possible to say with a high degree of probability what is with him, in which direction it is necessary to build a complex of examination. Olga Beklemishcheva: And what age, more precisely, age limits are just an alarming factor in terms of cholelithiasis? Sergey Shapovalyants: Well, usually it’s 40-50 years old and older. Often, these sufferings join and begin to manifest during pregnancy. Olga Beklemishcheva: And now Veronica Bode will introduce us to the news from Evgeny Muslin. The bird flu virus is not yet transmitted from person to person, but subtle, subtle mutations in its genetic makeup show that the fatal transformation has already begun and that the world is inexorably approaching a pandemic threshold.This opinion was expressed in the capital of Cambodia, Phnom Penh, by the UN coordinator in preparation for a possible global epidemic of influenza David Nabarro. “The H5N1 virus undergoes such mutations,” said Nabarro, “that make it more likely to become infectious. Although this process has been dragging on for several years, this does not mean that the danger has passed us.” Since 2003, the avian influenza virus has killed more than 70 people in Asian countries and forced the destruction of huge numbers of chickens and geese, causing significant damage to regional poultry farming.The World Health Organization warns that the virus’s ability to spread from person to person could lead to the death of millions of people. Speaking at the International Conference on Antimicrobials and Chemotherapy, World Health Organization consultant Benedetta Allegranzi said that in many countries, nurses, doctors and other hospital workers often spread infections because they do not wash their hands often enough. “Treating hundreds of millions of patients around the world,” she said, “is greatly complicated by the infections and illnesses they contract during their hospital stay.Unfortunately, only a small fraction of hospital staff adhere to important hygiene rules. ”At the University Hospital in Athens, Helen Giamarella presented the results of her three-year study to the Conference, according to which only 25 percent of doctors disinfect their hands before each new patient. morbidity, from infections picked up in American hospitals, 2 million people fall ill every year, and 90 thousand of them die.The main source of infections carried by dirty hands is staphylococcus, an antibiotic-resistant bacteria. Over the past 20 years, the number of staphylococcal infections worldwide has been increasing. The World Health Organization, in collaboration with other medical groups, is now planning to launch an international campaign to improve hospital hygiene. According to a Swiss study from the University Hospital in Zurich and published in the American journal The Heart, a few bites of dark chocolate a day can significantly reduce the risk of heart disease, as dark chocolate prevents hardening and loss of elasticity of the walls of the arteries. …To test how different types of chocolate affect blood circulation, the researchers selected a group of 20 heavy smokers, usually at greater risk of coronary artery disease. Each subject was given 60 grams of chocolate to eat, and two hours later, blood flow in their arteries was checked by ultrasound scanning. It turned out that dark chocolate, containing 74 percent cocoa, noticeably smoothed arterial blood flow, made it more laminar, while milk chocolate did not have a similar effect on blood.Although the researchers themselves consider their results to be preliminary, a small daily serving of dark chocolate, in their opinion, is clearly able to positively affect the health of the blood vessels. Olga Beklemishcheva: David got through to us from Zvenigorod. Hello David. Listener: Good afternoon. Please, tell me, maybe there are some medications available today that help dissolve stones, so that you might not go for an operation right away? Thank you. Olga Beklemishcheva: Thank you. Professor Shapovalyants, please. Sergey Shapovalyants: You know, the hopes for drugs, in particular, deoxycholic acid, they have a lot of commercial names, unfortunately, they are not justified. There are observations when it is possible to reduce the size of the stone or even dissolve the stones for a while, but under very harsh conditions – when the liver function is preserved, when there is complete patency of the cystic duct, when the bile is well concentrated, and hence the gallbladder preparation.But, unfortunately, most patients endure the course of this therapy rather uneasily. It is associated with dyspepsia, stool disorders, and abdominal distention. And as soon as they stop taking these drugs, unfortunately, the stones reappear. These are well-known facts that sometimes make it possible to postpone the moment of intervention for an indefinite period. But now it is impossible to say that there are reliable methods of conservative treatment of gallstone disease. Olga Beklemishcheva: Alexander Alekseevich, I would still like to ask you about the laser.Now there is a lot of talk that, perhaps, they will be able to somehow crush stones in the gallbladder with a laser. After all, it succeeded for the kidneys. Alexander Lindenberg: Yes, unfortunately, there is an opinion among the people that since this is successful for one organ, it should be crowned with success in the next organ. Unfortunately, this is not true. For one simple reason that the gallbladder and kidneys are completely different things. And what is possible to do with kidneys and kidney stones is absolutely absolutely contraindicated for the gallbladder.Here I would like to add that Sergei Georgievich did not name one more position – this is the already changed organ wall. The organ is sick. And therefore, remove stones from it, do not remove stones from it, we still leave a diseased organ in which, in the end, stones are formed again. And here we can recall a rather well-known operation at one time, which was called “ideal cholecystostomy”, when leaving the gallbladder, believing that it can be left, the stones were removed from it, and the bladder remained. Olga Beklemishcheva: There was such an option, right? Alexander Lindenberg: Yes, there was such an option historically a long time ago.And as practice has shown, stones formed again, and all patients returned to that old, most reliable operation, when the bubble is removed, which is actually called the “stone factory”. Olga Beklemishcheva: And the next listener is Alla Konstantinovna from Moscow. Hello, Alla Konstantinovna. Listener: Hello. Please tell me, if you observe fasting from young nails and carefully leave it, is it possible to reduce this terrible statistic when, as you said, there was a small number, but there was just a huge number of these diseases? Thanks. Olga Beklemishcheva: Sergei Georgievich, do you think this dietary regimen offered by, say, the Russian Orthodox Church, can it somehow affect stone formation? Sergey Shapovalyants: You know, here I cannot give such an unambiguous answer, convincing. Of course, a commitment to some kind of food, say, as we call it, Bavarian, replete with fatty, fried foods, certainly predisposes to the formation and formation of stones, understanding their components, consisting of a number of substrates that are characteristic of the food taken.But there is no direct relationship here. And we are well aware of very large groups of patients, scientific research is known, when vegetarians, people who ate fractionally all their lives and did not know, and never used the aforementioned fatty foods in their diet, unfortunately, they still have stones. And here we are talking about some kind of genetic predisposition, when the fragments that make up bile change. Fragments are a protein substrate, they are cholesterol, they are calcium salts, they are pigment components.Their ratio is violated – and this leads to the formation of stones. And to say that by excluding some food component it is possible to achieve a decrease in the so-called lithogenicity, that is, the tendency to form stones, unfortunately, this does not work. Olga Beklemishcheva: Moreover, dear listeners, prolonged fasting is one of the risk factors for cholelithiasis. So unfortunately it is. Sergey Shapovalyants: Such facts are known. Olga Beklemishcheva: But still I would like to ask you to tell in more detail about the method of treatment of postcholecystectomy syndrome that you are using and developing. Sergei Georgievich, you have already said that this syndrome can be conditionally divided into two groups. One group is when some other diseases were overlooked, the contribution of which to the picture of biliary colic turned out to be much more significant than the stones themselves. And the second is the true postcholecystectomy syndrome.I have already said that the recommendations that I met in the public domain, they were limited to dietary and sanatorium appeals. And I already told the audience that, in your opinion, this is wrong. How will be correct? If we take, of course, the true postcholecystectomy syndrome. Sergey Shapovalyants: We are talking about the formed pathology of the main bile ducts. We are talking about the pebbles that are formed there. And, as a rule, this accompanies the process in that part of the biliary tract, where the place of confluence of the bile ducts into the duodenum is located.Some narrowing is formed there – this is the so-called large papilla of the duodenum, where the bile ducts flow into the duodenum. And now, a slowdown in the flow of bile due to constricting processes leads to the formation of stones or contributes to this fact to a large extent. And this method – the so-called endoscopic retrograde cholangiopancreatography – allows you to find out all the circumstances – and the state of this large duodenal papilla, inject a contrast agent through it into the bile ducts, find out their condition, the presence of stones and, most importantly, continue this into the treatment procedure in the form of a dissection of this section of the bile duct with special instruments and extraction of stones with baskets. Olga Beklemishcheva: How is it with baskets? That is, bring a special basket and put them there, and then pull them out, right? Sergey Shapovalyants: Yes. A special basket is carried to the level of the stone and removed. This technology has been known for over 30 years. Until now, she continues to improve. And with good, so to speak, personal experience of the researcher, it gives good results, finished, is relatively safe, I will not say that it is safe, it is certainly a delicate and fraught procedure, since this is a very delicate anatomical area.But this is a method that is accepted all over the world, and leads to a successful healing without traditional intervention. If before the introduction of this method it was necessary to do repeated traditional operations, now this time has been forgotten. Olga Beklemishcheva: Great! But this also means at the same time that if a person has exactly this true postcholecystectomy syndrome, then dietary regimens or rest in a sanatorium, unfortunately, will not help him, and moreover, he may find himself in a situation where he has an attack, and he is far from your doctor, from a good medical center. Sergey Shapovalyants: Of course. The point is that these stones are of different sizes and configurations, they can wedge into a very important area, where the pancreatic duct also flows. And then a complication may arise when time has already passed for hours, and the rapid development of the disease can lead to very dramatic consequences. Olga Beklemishcheva: And the next listener is Yuri from Moscow. Hello Yuri. Listener: Hello.I have a question for the guests. Tell me, what if I was diagnosed with calculous cholecystitis in the form of sand up to 2 millimeters? Well, I also had seizures. I was admitted to the hospital with a seizure. They wanted to operate on me, but then they refused. They said that I have problems with the pancreas, that I have amylases. Then, although they brought her back to normal (I was in bed for nine days), they discharged me. But they told me to come back to the ambulance again. How to appear? What, to wait for an attack again or what? And further. If you are performing treatment and surgery, how can you contact you? And how much does it cost? Olga Beklemishcheva: Thank you.Sergey Georgievich, please. Sergey Shapovalyants: You know, 2 millimeters is still not sand, these are already formed stones. These stones are small. But it is precisely this size of calculi, stones that is characteristic of this movement into the bile ducts, into the zone that we just talked about. Olga Beklemishcheva: With all the attendant circumstances. Sergei Shapovalyants: And exactly the very complication that we just said is pancreatitis associated with the fact that this stone, well, this time passed safely, migrated, as we say, into the duodenum, and this attack was stopped.Judging by your preliminary story, we are probably talking about the need for surgery and removal of the gallbladder with these small stones. I will tell you that if you live in Moscow and go to the 31st hospital, where the forces of both the department and our very large team, which for many years and now continues to be headed by Academician Pantsyrev Yuri Mikhailovich, and through the efforts of our chief physician, he is also an academician , all the conditions for the modern treatment of patients with calculi of the extrahepatic bile ducts and gallbladder, they exist at a very good level.And for the residents of Moscow, all this is done free of charge. Olga Beklemishcheva: Draw conclusions, dear Yuri. The next listener is Lidia Ivanovna from Moscow. Hello. Listener: Hello, dear compatriots. I live right next to the 31st hospital. And I want to say that the employees of the 31st hospital are deeply respected. Thank you. Three years ago, during the examination, a stone of 1.5 by 2 centimeters was found in my gallbladder.And they offered me a planned operation, which I refused. But more than three years ago I took courses from the rector of the Novosibirsk University of Youth and Health, Nikolai Konstantinovich Pirozhkov, who teaches how, without drugs, leading a healthy lifestyle, to turn air, sun, water, food, and so on into medicine. And I immediately switched to separate meals, when proteins and carbohydrates are not mixed in one meal, and the next meal is not less than two hours later, and the food compatibility is strictly according to Shelton’s table.I feel great. There was no pain in the gallbladder and no. I have no pain at all. And, oddly enough, I am getting younger both externally and in spirit. Olga Beklemishcheva: Lidia Ivanovna, we are very happy for you. What is your question? Listener: If the bladder has not been functioning for a long time, what are the symptoms? And which stones are considered small? Thank you in advance for your response. Best regards to your transfer. Thanks. Sergey Shapovalyants: I would like to say the following that in your case we have a successful course of cholelithiasis.And this is not uncommon. I do not want to upset anyone, but, unfortunately, the fate of patients in such cases is unpredictable. I congratulate you on the fact that with some complex of conservative measures you managed to soften the course of the disease and get such a relapse-free period. But if you came to our appointment, we would still offer you a surgical intervention, explaining all the possible, probable and undesirable complications of this disease. This is where the challenge lies before us. And the choice, of course, is yours.And one more little recommendation. Do the ultrasound again. Was there a stone? .. Olga Beklemishcheva: The fact is that sometimes on an ultrasound scan they just take a clot of bile for a stone. You know, and I also want to ask our American colleague, Professor Daniil Borisovich Golubev. As far as I understand, in America there is also some friction between the supporters of conservative and surgical methods of treatment for cholelithiasis. According to American experts, is surgical intervention always justified? Is it justified that doctors always recommend that a person has a successful gallbladder with calculous cholecystitis? Daniil Golubev: In the USA, it is quite widespread, especially among physicians, that there are too many surgical interventions in modern medicine and that the possibilities of non-surgical treatment of certain diseases are ignored or underestimated.There are even people who are radical in this regard, such as, for example, Nobel Peace Prize laureate cardiologist Bernard Lane, who calls this trend in American medicine “criminal.” This applies primarily to cardiac surgery, but also applies to other areas, in particular, to the practice of surgical removal of the gallbladder. A number of experts believe that when symptoms of gallstone disease occur, you should not rush to remove the gallbladder, since the total risk to health and even life from the removal itself and its consequences exceeds the risk due to the tactics of “patient waiting” and conservative treatment of the disease.The constant secretion of bile into the intestine without the regulatory influence of the gallbladder leads to diarrhea, that is, diarrhea, and other manifestations of intestinal discomfort, and with prolonged exposure to the mucous membrane, it can contribute to the occurrence of colon cancer. So a large number of people without a gallbladder is not a reason for reckless joy. Olga Beklemishcheva: As a matter of fact, no one was happy. It just seems to me that there is cancer, and there is cancer. As far as I understand, the preservation of stones in the gallbladder is also a reason for oncological alertness, isn’t it, Alexander Alekseevich? Alexander Lindenberg: Well, prolonged stone carriage can lead to the development of gallbladder cancer.Although, as a rule, we believe that the combination of “gallbladder cancer and gallstones” is quite rare. Olga Beklemishcheva: Usually it’s different, right? Alexander Lindenberg: No, there will be one clinic, the clinic will be cholelithiasis, colic. Still, we meet gallbladder cancer less often than stone carriage. Olga Beklemishcheva: And there is cancer without stones? Alexander Lindenberg: It happens.But more often there are stones and cancer at once. Sergey Shapovalyants: It should be emphasized that more than 90 percent of cases of gallbladder cancer occur against the background of prolonged stone carriage, against the background of a recurrent course of calculous cholecystitis. This is a well-known fact. Olga Beklemishcheva: So, dear listeners, if you have stones, it’s still better to think about removing them. And the next listener is Daniel from St. Petersburg.Hello Daniel. Listener: Good afternoon. This is the question I have for you. I was diagnosed with calculous cholecystitis on ultrasound. They recommended, however, to do a gastroscopy, since an ultrasound scan showed that there was something incomprehensible in the large duodenal papilla, some kind of dark spot – either a polyp or a diverticulum. And gastroscopy showed that I … however, do not have any lateral optics, which seems to be needed in this case, but, nevertheless, they wrote that the large duodenal nipple is normal.What should I do? Should I be afraid of surgery or not be afraid of surgery to remove the gallbladder? Thanks. Sergey Shapovalyants: I can give some explanations on this issue. The study of this anatomical zone – I mean this large duodenal nipple, which our patient has just mentioned, – nevertheless, more accurate information about this anatomical zone is given with the help of endoscopes with so-called lateral optics. That is, it allows, from all sides, to target and evaluate the state of this anatomical zone.If doubts arose in this sense, then, of course, this circumstance must be clarified to the end. Olga Beklemishcheva: That is, to go for a gastroscopy with this lateral optics? Sergey Shapovalyants: I have to go for endoscopy with a duodenoscope with lateral optics. Olga Beklemishcheva: That is, Daniil, you need to repeat the procedure in a more serious institution with good equipment. Sergey Shapovalyants: But in fact, these statements are preliminary, they require a deeper study of the issue.In particular, we have already mentioned duodenoscopy with lateral optics. And it is likely that some kind of radiation methods in the form of computed tomography will be required to determine the state of the area of ​​the large duodenal nipple, the head of the pancreas and this section of the bile and pancreatic ducts. This requires mandatory clarification. Since some speck has been found there, then this must be clarified to the end. Otherwise, you can get the very notorious syndrome that we are talking about, and in a very serious form. Olga Beklemishcheva: And Maria Alekseevna phoned us from St. Petersburg. Hello Maria Alekseevna. Listener: Hello. Could you please tell me what to do. I did an ultrasound scan last year. I was told that my gallbladder is clogged with bile. Olga Beklemishcheva: Is it clogged with bile? But it should be so. Maybe stones? Listener: Bile. They say that there is a lot of bile.And at night I have such pains … Alexander Lindenberg: I see. In this situation, it is possible to recommend that the patient still repeat the examination. Because what was said to her in the place where she was studied, in general, sounds very incorrect. There are atonic forms of the gallbladder, that is, the ultrasound was produced at a time when the bladder was not emptied. But to say about this that this is a pathology or this is the norm is almost impossible. Olga Beklemishcheva: Well, yes, it’s like saying after dinner that “your stomach is full of food.”Really packed, but you just had lunch. Alexander Lindenberg: For some reason today I am playing the role of a historical reference. Once upon a time, a patient was given a raw egg to eat in order to watch the bladder contract. You don’t need to do this now. Research methods allow you to see how it will shrink. Olga Beklemishcheva: Moreover, raw eggs can bring you salmonellosis. Alexander Lindenberg: Yes, probably.And therefore, in this situation, there is no need to talk about any correct diagnosis. And it is necessary to be examined. Because underneath it can hide another heel of diseases associated with poor emptying of the gallbladder. Olga Beklemishcheva: So please repeat the study, but in a more serious institution. All the best! Try not to get sick.

Postcholecystectomy Syndrome (PCES) | Family Clinic “Ameda”

Postcholecystectomy syndrome is a complex of symptoms that develops after surgery to remove the gallbladder.The disease is manifested by recurrent pain attacks, indigestion, diarrhea, steatorrhea, hypovitaminosis, and weight loss.

After removal of the gallbladder, does the right side hurt ? You may have developed postcholecystectomy syndrome. To get rid of it, you need to undergo timely examination and treatment.

PCES occurs in approximately 10-15% of patients. In women, it is diagnosed almost 2 times more often than in men. Postcholecystectomy syndrome may appear immediately after surgical removal of the gallbladder or may occur over a long period of time (several months or even years).

Postcholecystectomy syndrome: causes of development

Postcholecystectomy syndrome causes a disturbance in the outflow of bile after surgery to remove the gallbladder, which was a reservoir for its storage and took part in its release into the duodenum – in a timely manner and in sufficient quantity.

Postcholecystectomy syndrome: symptoms

Postcholecystectomy syndrome may present with preoperative symptoms, but are usually less severe. In most cases, we are talking about pain in the right hypochondrium, because after removal of the gallbladder, the right side hurts . The pain can be different – sharp or dull.

The second most common symptom is a dysfunction of the digestive tract, which is manifested by nausea, bloating, rumbling in the abdomen, belching, heartburn, diarrhea.Such violations lead to a deterioration in the absorption of food in the duodenum and the occurrence of malabsorption syndrome. As a result, postcholecystectomy syndrome can lead to hypovitaminosis, general weakness, weight loss, stomatitis.

In addition, body temperature may rise, jaundice of the skin and sclera may appear. In general, postcholecystectomy syndrome can be expressed by various pathologies of the liver and other organs of the digestive system.

Postcholecystectomy syndrome: diagnosis

When there is a suspicion of postcholecystectomy syndrome, diagnosis of the developing disease may be difficult due to unclear or mild symptoms.

To facilitate the diagnosis and determine the causes of this condition, general and biochemical blood tests, as well as ultrasound and CT of the abdominal cavity, fibrogastroduodenoscopy are performed.

Treatment of postcholecystectomy syndrome

The choice of PCES treatment method depends on the reasons that caused it.

Postcholecystectomy syndrome can be treated conservatively (sparing diet, taking enzymes and antispasmodics).

In the case when the prescribed treatment does not bring relief, it is also possible to use a surgical method of treatment (drainage and restoration of the patency of the bile ducts).

After removal of the gallbladder, does the right side hurt ? Contact the Ameda Family Clinic – our best gastroenterologists will be able to save you from postcholecystectomy syndrome and other pathologies in the digestive system!

Removal of the gallbladder (laparoscopic cholecystectomy)

Laparoscopic gallbladder removal (laparoscopic cholecystectomy) is a modern way to remove the gallbladder without wide incisions through several small punctures of the anterior abdominal wall.The operation is carried out with the help of special manipulator instruments and an endoscope – a high-tech device with a video camera that transmits the image to the monitor screen.
Please note: laparoscopy for removal of the gallbladder is today the “gold standard” in the treatment of gallstone disease. “Open” operations with a large incision are currently performed only with the development of complications of gallstone disease, including perforation of the gallbladder, peritonitis, anatomical anomalies.

In what cases is the gallbladder removed?

Your doctor may refer you to surgery to remove your gallbladder if you have:

• Choledocholithiasis – a form of gallstone disease in which stones form in the lumen of the common bile duct
• Blockage of the biliary tract
• Acute cholecystitis – if the disease has arisen against the background of an existing gallstone disease, the doctor may decide on an urgent operation
• Cholelithiasis (cholelithiasis) with attacks of biliary colic or with the manifestation of “small” symptoms of the disease: bitterness in the mouth, aching pain in the hypochondrium on the right and a feeling of heaviness after eating in the same area
• Asymptomatic gallstone disease
• Calcification of the gallbladder
• Polyps of the gallbladder with gallstone disease or at risk of developing a tumor
• Perforation of the gallbladder – malignant tumors, severe abdominal trauma and a number of systemic diseases can lead to this disease
• Cholesterosis – the deposition of cholesterol on the walls of the bladder against the background of cholelithiasis
• Development of secondary pancreatitis

These are the main problems in which the gallbladder is removed.How much removal is necessary in your case, the attending physician will determine based on the results of a thorough preliminary diagnosis and your general condition.
It is important to know: if the operation is not done on time, sooner or later there will be serious complications that can cost you your life.
Therefore, do not delay the visit to the doctor. Make an appointment and undergo preliminary diagnostics.

Is it necessary to remove the gallbladder?

Why is the gallbladder necessarily removed? Can’t you just remove stones or polyps?

These questions are of concern to most patients.Alas, you cannot leave the gallbladder, because:

1. . Bile will interfere with the normal healing of the gallbladder wall after surgery.
2. . Bile can enter the abdomen and cause peritonitis.
3. . Simply removing stones does not mean getting rid of gallstone disease, since they are formed again.
4. . Even with successful healing of the gallbladder wall, a scar will remain, in which bile particles will crystallize and stones will form.
5. . After the operation, adhesions are often formed that interfere with the normal flow of bile, as a result of which it will stagnate, and this will sooner or later cause cholestasis.

Operations to remove the gallbladder

In traditional cholecystectomy, a rather large incision of about 15-20 cm is made on the anterior abdominal wall, through which the gallbladder is removed.

Laparoscopy of the gallbladder has a number of advantages over traditional cholecystectomy:

• The gallbladder is removed through small, neat punctures instead of a large incision: after surgery, you leave almost invisible specks instead of an extensive scar
• You recover quickly: up to 2-3 days in a hospital and up to 7 days on an outpatient basis
• Laparoscopy of the gallbladder is performed practically without blood loss
• The risk of complications after surgery (suppuration, formation of adhesions, etc.) is practically zero
• After surgery, you will need much less pain relievers or not at all

Preparation for operation

Preparation for the operation is the most important stage on which the success of the future operation largely depends.Preliminary diagnostics helps to assess the general condition of your body, to exclude infections, allergic reactions and other pathologies for which the operation is contraindicated.

These are the key tests and examinations that you undergo before removing the gallbladder:

1. . General and biochemical blood and urine tests.
2. . Tests for syphilis, hepatitis B and C.
3. . Coagulogram.
4. . Determination of blood group and Rh factor.
5. . Ultrasound of the gallbladder, biliary tract and abdominal organs.
6. . ECG.
7. . Radiography of the lungs.
8. . Fibrogastroscopy or colonoscopy – if necessary.

If necessary, other specialists are involved for comprehensive diagnostics – gastroenterologist, cardiologist, endocrinologist, allergist. This approach helps to understand your condition in detail, choose anesthesia and correctly control the body’s work during the operation.

How to prepare the intestines?

3 days before gallbladder laparoscopy, exclude bread, vegetables, fruits. To cleanse the intestines, on the eve of the operation, it is necessary to put an enema (about 1.5 liters of liquid) or take the drug “Microlax”.
In the evening before the operation, you can eat a light dinner, for example, porridge or dairy products – cottage cheese, yogurt or kefir.
Important: Do not eat or drink within 8 hours prior to surgery.

How is the removal of the gallbladder going?

Laparoscopy of the gallbladder is performed under general anesthesia and takes 20 minutes to 1.5 hours:

• The doctor makes several small punctures of the abdominal wall and inserts instruments through them – trocars, an endoscope and special manipulators
• Gas is pumped into the abdomen, which improves visibility
• The doctor clamps the cystic duct and artery with a special instrument and cuts them off
• After that, the doctor removes the gallbladder from the abdominal cavity, removes the instruments and sutures the holes

Sometimes a drain (a thin tube to drain fluid) is inserted into the wound, which is removed the next day if there is no discharge.
After removal of the gallbladder, you are transferred to the recovery room, where you are under the supervision of specialists for 1 to 3 days.

Possible complications after surgery

In most cases, there are no complications after laparoscopy of the gallbladder, since there are no large incisions, sutures, and blood loss during the operation is minimal. But, like any surgical intervention in our body, this operation can cause a number of rare complications, including:

• Suture suppuration
• Bleeding in the abdomen
• Bile leak
• Adhesion
• Injury of the bile ducts during surgery
• Allergic reactions
• Thromboembolic consequences
• Exacerbation of another chronic disease

These complications are extremely rare.As a rule, this occurs in elderly people, or when there is a severe concomitant pathology or severe damage to the biliary tract.
If you feel unwell after the operation, immediately inform your doctor about it, who will prevent further complications.

Do stones form after gallbladder removal?

The operation to remove the gallbladder does not change the composition of the bile. Hepatocytes continue to create abnormal bile, which can cause stones to form again.That is why, even after surgery to remove the gallbladder, you need to regularly undergo a study of the composition of bile.

Rehabilitation after removal of the gallbladder

After 4-6 hours after removing the gallbladder, you can already eat light food, drink water, get out of bed and walk. The main thing is to do it carefully, as after anesthesia you may be weak and dizzy.
Pain after surgery is minimal and does not require a lot of analgesics.And many people do not need pain relievers at all.
You will be discharged in 1-4 days. And in 15-20 days you will be able to return to work.
Limit physical activity: do not lift more than 2-3 kg and do not do exercises that use the abdominal muscles.
Please note: proper nutrition after removal of the gallbladder is one of the most important factors in recovery.

Nutrition after removal of the gallbladder

Without the gallbladder, bile constantly enters the intestines from the liver.Proper nutrition will reduce its toxicity and help preserve the intestinal mucosa.
For the first month after surgery, eat 5-6 times a day, but not much, and drink up to 1.5 liters of water a day. Of the products during this period, you can eat white bread, boiled meat and fish, cereals, jelly, dairy products, stewed or steamed vegetables.
Take your time and chew food thoroughly: this will help activate the necessary enzymes and “turn on” the liver.
Six months after the operation, you can gradually expand the diet.Eat berries, fruits, and vegetables other than onions, garlic, radishes, and lemons. You can eat honey and dried fruits.
Alcohol, sweets, pickles, fatty and fried foods will have to be limited forever.
Fermented milk products with live bifidobacteria, which improve the intestinal microflora, will also be useful for you.
If necessary, your doctor will prescribe choleretic herbs and preparations with the necessary enzymes.

Drug treatment and gymnastics

After removal of the gallbladder, it is vital to restore the normal functioning of the body and adapt all systems.To do this, the doctor will select an individual drug therapy for you, consisting of choleretic and enzyme preparations, as well as drugs that restore the intestinal microflora.
Physical activity is necessary a few months after the operation.
Physical activity is necessary a few months after the operation.
Take half an hour walks every day, and do gymnastics in the morning. This will help oxygenate the body and activate the abdominal organs.

Removal of the gallbladder in the Stolitsa network of clinics is:

High-tech

To effectively carry out low-traumatic operations to remove the gallbladder, we use modern premium video equipment “PENTAX”.Thanks to its powerful optical system, it allows the doctor to examine in detail the condition of the gallbladder and safely remove it.

Professional

The experience and professionalism of a doctor is the key to a successful operation. Indeed, without a highly qualified specialist, even the most premium equipment is just apparatus. Only an experienced doctor can perform laparoscopic surgery professionally and safely for your health.
Over the years of successful practice, our specialists have performed a huge number of laparoscopic operations to remove the gallbladder and have returned health to hundreds of people.
Turning to us, you can be sure that our specialists will thoroughly understand your situation: they will conduct a detailed preliminary diagnosis and determine exactly how necessary the removal of the gallbladder is.
Before the operation, we conclude a formal contract with you. You will receive all the necessary documents.
The price under the agreement includes the payment for the operation itself, the cost of anesthesia and postoperative observation in the clinic.
After the operation, you will receive a sick leave from the first day of hospitalization, which, if necessary, you can extend either in our clinic or in your local clinic.
After being discharged, you will receive a discharge summary with the operation protocol and detailed doctor’s recommendations for treatment during the rehabilitation period.

Comfort

In our cozy rooms you will feel comfortable, because they have everything you need: a button to call a nurse at any time of the day, a separate bathroom, air conditioning, refrigerator, TV, microwave oven and Wi-Fi.
After the operation, our specialists will continuously monitor your condition.
Adequate nutrition and rehabilitation procedures will help you quickly recuperate after surgery and return to a fulfilling life.
Get your health back. Make an appointment now.

90,000 Indications for removal of the gallbladder

In some situations, removal of the gallbladder (cholecestectomy) is the only correct choice that will preserve the health and life of a person.

For what lesions of the gallbladder this operation is indicated :

• Recurrent bouts of biliary colic, frequent and painful – removal of the gallbladder is performed routinely.

• Calcified (“porcelain”) gallbladder – routinely removed.
Such a gallbladder can no longer cope with its work, but can only become a source of trouble.

• Acute cholecystitis (complicated forms or in the absence of improvement on the background of drug treatment) – removal of the gallbladder urgently (in the next 48-72 hours).

• Postponed acute cholecystitis in the past – removal of the gallbladder in a planned manner.Better after 4-6 weeks, maximum after 12 weeks. This is done in order to avoid repeated attacks of acute cholecystitis (and its probability after already suffered cholecystitis is almost 100%).

• Choledocholithiasis (presence of stones in the common bile duct) – a stone is removed from the duct. In this condition, it is often necessary to perform the removal of the gallbladder at the same time.

• Attack of acute pancreatitis caused by stones from the gallbladder – the gallbladder is removed after the symptoms of pancreatitis have subsided in order to avoid these attacks in the future.

• Acute pancreatitis is a life-threatening disease of the pancreas and should be avoided.

• “Acalculous cholecystopathy” – routinely in the presence of certain conditions. In Russia, it is not an absolute indication for cholecystectomy.

In other cases, you need to try to cope with the problem with medication and diet. The method of treatment is determined by a specialist on the basis of an examination.

Life without a gallbladder is quite comfortable and the body adapts to it from six months to one and a half years.Bile in a person without a gallbladder does not accumulate, but constantly enters the duodenum.

Of course, in the new conditions, for good health, you will have to adhere to a special diet – to reduce the amount of fat, sweet, starchy, strong coffee and tea, not to mention tobacco and alcoholic beverages. In general, such a diet contributes to the healing of the whole body.

indications, analyzes and the course of the operation, price – Central Clinical Hospital of the Russian Academy of Sciences, Moscow

A healthy gallbladder is an important and necessary organ involved in digestion, but with pathological changes, its normal work is impossible.On the contrary, the altered gallbladder becomes a source of problems – it is a potential focus of pain and the development of infections. Therefore, its removal does not have a serious effect on physiological processes, making it easier for a person.

Types of cholecystectomy

If the therapeutic treatment of gallbladder does not bring results or there are clear indications for surgical intervention, the doctors of the clinic of the Central Clinical Hospital of the Russian Academy of Sciences in Moscow will give recommendations on the choice of the method of operation. This can be a classic open cholecystectomy, endoscopic gallbladder surgery, or mini-access surgery.

• Laparoscopic cholecystectomy is an intervention characterized by minor surgical trauma, fast and fairly easy recovery. Instruments and a video camera are inserted through punctures in the abdominal wall. As a result of air injection, an overview is provided for the necessary operations. In some cases, upon completion of the operation, the doctor ensures that fluid from the subhepatic space is drained. After 2-3 days, the patient leaves the department on his own and recovers at home.
• Operation from a mini access (incision 3-7 cm) – the objective desire of most patients is to conduct a laparoscopic operation of cholecystectomy of the gallbladder. However, this type of surgical treatment is not suitable for all clinical cases. In order to reduce the degree of trauma during gallbladder removal, a decision can be made to perform an operation from a mini-access under the right costal arch – this is a compromise option between traditional abdominal surgery and laparoscopic surgery.

If you are indicated for a planned operation (laparoscopic cholecystectomy), contact the specialists of the Central Clinical Hospital of the Russian Academy of Sciences. In a modern hospital, we carry out at a high level any operations to remove bile – single-port, retrograde (from the neck), antegrade (from the bottom). You can clarify the cost of the operation in the price list on the clinic’s website. However, it is better to get all the information on the assessment and recommendations for the type directly at the consultation of the specialists of the Central Clinical Hospital.

Laparoscopic cholecystectomy is a minimally invasive operation to remove the gallbladder using laparoscopic technology – through a centimeter incision.Today, this is the only way to routinely treat chronic cholecystitis.

The operation is considered the most frequently performed of all those performed on the internal organs.

Advantages of using the method

• Reduced pain after surgery.
• Short hospital stay (less than a day).
• Rapid return of the patient to the usual organization of life.
• Good cosmetic effect.
• Improving the quality of life.
• The likelihood of developing a ventral hernia is practically excluded.
• Minimal trauma to the abdominal wall.

Indications for laparoscopic surgery

First, a decision is made on the need for an operation, and then a technique is selected. Currently, the use of the laparoscopic technique is considered justified at any age of patients, even if they are overweight.

Laparoscopic cholecystectomy is indicated for the following diseases:

• Cholecystitis refractory to conservative treatment;
• Cholesterosis of the gallbladder;
• Cholecystitis in the acute stage;
• Cholecystolithiasis, asymptomatic;
• Tumors of the gallbladder (including papillomas).

If the disease is accompanied by pain, patients are not surprised at the scheduled surgery.

When the disease is asymptomatic and is detected incidentally, surgical treatment is also recommended. In this case, the operation is easier to transfer.

With this diagnosis, the development of papillomas – benign tumors is possible, therefore the operation begins with a detailed examination of the cavity for the growth of tumor formation. If there are doubts about the benign quality of the formation, a transition is made from laparotomy to an open type of surgical intervention – abdominal surgery.

When is laparotomic cholecystectomy not acceptable?

Absolute contraindications:

• Poor blood clotting;
• Pathology of vital functions in the stage of decompensation;
• Critical condition of the patient.

Relative contraindications are determined, as a rule, by the staffing of the clinic with modern equipment, the individual characteristics of the patient and the experience of the surgeon.The question of applying the technique is a joint decision of the surgeon and the anesthesiologist.

There are situations when it is not possible to perform the operation due to anatomical abnormalities or an inflammatory process. In these cases, an open operation is performed.

Preparatory period

A survey is being carried out to assess the state of the body and identify concomitant diseases:

• Physical examination:
• Blood and urine tests;
• ultrasound of internal organs;
• ECG;
• X-ray or chest x-ray;
• Medical examination;
• Esophagogastroduodenoscopy.

This list can be expanded with colonoscopy, MRI and endoscopic retrograde cholangiopancreatography.

In addition, you need:

• Introduce only light food in advance;
• Put a cleansing enema twice before the operation – in the evening and in the morning;
• If necessary, espumisan may be prescribed;
• Take a shower.

All medications are taken only in consultation with the doctor.

Progress

Laparotomic cholecystectomy is performed under general anesthesia and lasts approximately 40 minutes. The steps in the procedure are as follows:

• Carbon dioxide is injected into the abdominal cavity.
• Tubes with valves are inserted so that you can insert instruments without releasing gas, and a tube with a video camera – a laparoscope. The monitors show the progress of the operation with multiple magnifications.
• Place trocars.
• Special instruments hold the gallbladder, clamp the duct and artery with clips.
• The gallbladder is separated and removed.
• The abdominal cavity is drained.

Rehabilitation

The patient spends the first postoperative hours in intensive care, then he is transferred to the ward. After a few hours, you can get up. The drain is removed the next day. Recovery takes place within a month after surgery:

• It is necessary to observe the daily routine;
• Take prescribed medications.
• Gradually introduce physical activity.

The need to follow a diet exists only in the first months after the operation, while the body is adapting to new conditions. Within six months, the restrictions are removed.

Regarding the results of laparotomic cholecystectomy, it is worth noting that the operation is considered the standard method of treatment. The main advantage is quick recovery. The technique is safe, the frequency of conversions to an open operation is minimal.

Complications

The following negative consequences are possible:

• Outflow of bile into the abdominal cavity if the cystic duct is poorly sutured;
• Peritonitis;
• Inflammatory process;
• Hernia.

Reviews

Almost all the reviews of our patients are positive – the operation is considered effective, quick and low-traumatic. Unpleasant moments that patients pay attention to:

• Abdominal pain due to bloating;
• Difficulty breathing because the lungs were compressed;
• We have to starve for the first time.

All these sensations pass quickly. The operated patients agree that these symptoms can be endured, they are incomparable with the benefits of the operation.

Where is the best laparotomy done?

The cost of laparoscopic surgery is slightly higher than that of open surgery, when the muscles of the abdominal wall are transected. However, taking into account the reduction in the time spent in the hospital, the total costs of treatment are lower than with abdominal surgery.

You can find out the cost of surgical treatment at the consultation of a specialist from the Central Clinical Hospital of the Russian Academy of Sciences in Moscow or by calling the clinic.

90,000 Treatment of gallbladder diseases – Services

Despite its small size, the gallbladder is an important organ in the digestive system.It performs the function of collecting bile from the liver and regulating its excretion into the duodenum, depending on the food intake.

The function of bile is to activate digestive enzymes in the intestines and emulsify fats (the process of breaking down large droplets of fat into smaller ones) to facilitate the digestion process. In addition, resorption (reabsorption) of protein, important salts, amino acids into the blood occurs in this organ, as well as the secretion of mucus and a special hormone – cholecystokinin.

Cholecystokinin (CCK) – is a neuropeptide hormone produced by the intestinal mucosa. It is responsible for: reducing the release of hydrochloric acid; stimulation of the pancreas, digestive enzymes, bile secretion, contraction of the gallbladder, is directly related to the relaxation of the bile duct sphincters and stimulation of the vagus nerve. Lack of this substance in the body is fraught with:

• Disorders in the work of the gallbladder
• violation of the flow of bile into the duodenum
• disruption of the digestive tract in general

In addition, this hormone is involved in maintaining calmness, regulating sleep, suppressing fear and pain, and mental stress.

Gallbladder: interesting facts

• The gallbladder contains about 50 ml of bile produced in the liver cells, then through special bile ducts, which form a complex network, it enters the gallbladder, where it is stored until a person is eaten
• As soon as food enters the duodenum, the gallbladder contracts, and bile, along with pancreatic juice, moves into the intestines
• A healthy person can produce from 500 to 1000 ml of bile per day

• It contains water, bile acids, inorganic substances, vitamins A, B, C, D, amino acids, phospholipids, cholesterol, bilirubin, proteins, mucus and drug residues
• Bile functions: neutralization of gastric juice; activation of intestinal and pancreatic enzymes; inhibiting the growth of harmful bacteria in the intestines; improvement of intestinal motility; elimination of toxic substances and drugs

Main pathologies of the gallbladder

Cholelithiasis (cholelithiasis) is a disease of the biliary system associated with disorders of bilirubin metabolism and cholesterol, characterized by the formation of stones inside the liver, in the common bile duct and in the gallbladder.

According to the mechanism of formation, 3 types of stones are distinguished:

• cholesterol
• pigment bilirubin brown
• black

Cholelithiasis can be asymptomatic for a long time, sometimes manifesting itself in the form of attacks of hepatic colic.

Chronic stoneless cholecystitis is a long-term inflammatory process that affects the inner membrane of the bladder and is not accompanied by the formation of stones.

The main causes of the disease:

• bacterial infection – intestinal microflora (Escherichia coli, enterococcus), staphylococci and streptococci, Proteus, typhoid and paratyphoid sticks, anaerobic microflora
• parasitic invasion – feline fluke, lamblia, roundworm
• reverse flow of bile from the intestine – dangerous by the pancreatic enzymes in it, which, when entering the bladder, begin to digest its wall (this pathology is also called chemical cholecystitis)
• Allergies – food and aerogenic allergens
• inflammatory diseases of the digestive system – especially negatively affected by hepatitis and pancreatitis
• bile stasis

Biliary dyskinesia is a functional disease of the biliary tract associated with a change in the tone of the gallbladder or ducts.As a rule, it is accompanied by periodic pain in the right hypochondrium and dyspeptic disorders. Dyskinesia usually occurs with constant stress, psycho-emotional stress, neuroses. Depending on the change in the tone of the bladder, pain (hyperkinetic) and dyspeptic (hypokinetic) types of the disease are distinguished.

Acute cholangitis is an inflammatory process in the stage of acute exacerbation, which affects the bile ducts. It usually occurs as a complication of chronic cholecystitis, cholelithiasis, or after removal of the gallbladder.The development of infection is facilitated by stagnation of bile, compression of the ducts by tumors, stones. There are obstructive, recurrent, bacterial, secondary sclerosing cholangitis.

Cholecystitis – inflammation of the gallbladder. Signs of the disease – pain in the right hypochondrium of a pulling nature, may increase after eating. Drug treatment – antibiotics, choleretic and anti-inflammatory drugs.

Cholesterosis – the process of deposition of cholesterol in the walls of the gallbladder, does not manifest itself for a long time.Treatment – diet and diet.

Polyps – a benign tumor, asymptomatic, except in cases of blockage of the exit from the gallbladder. Treatment is surgical removal of polyps.

Cancer of the gallbladder is a rather rare pathology, in most cases it is the outcome of a chronic inflammatory process in the organ. Treatment is removal of the gallbladder and chemotherapy. Allocate adenocarcinoma, mucous, solid and squamous cell carcinoma.Gallbladder cancer is characterized by high malignancy, early metastasis and invasion of adjacent organs.

Please note

• Diseases of the gallbladder are the second most frequent diseases of the liver and biliary tract and the third most frequent among all diseases of the gastrointestinal tract.
• With regard to age, they are more often affected by people over 50 years old, and women are more affected than men.

Symptoms of gallbladder diseases

• Pain – localized in the hypochondrium, of varying intensity (less with the bend of the gallbladder, more pronounced with cholecystitis and stones, may be absent with polyps).The pain increases within 24 hours after eating, especially fatty, fried or smoked food. If a stone leaves the gallbladder and blocks the common bile duct, a sharp paroxysmal pain occurs – hepatic colic
• Nausea, intermittent vomiting, flatulence (bloating) and stool disorders (loosening or a tendency to constipation) – these symptoms of digestive disorders are associated with the flow of bile into the intestines in an incomplete volume or a change in its composition, the process of food digestion is disrupted
• Bitter taste in the mouth – accompanies almost all diseases of the liver and gallbladder
• Raspberry tongue – redness of the tongue, a specific symptom of various problems with the liver or biliary tract

• Intense color of urine – the urine becomes deep yellow, up to brown.This is due to the fact that in diseases of the gallbladder, bile acids are partially absorbed into the blood and excreted in the urine, which gives it a characteristic staining
• Light stool – normally brown stool is provided by the presence of bile acids in it, respectively, with a decrease in the flow of bile into the intestines, the stool becomes light
• Jaundice of the skin and sclera (from subtle to pronounced yellow coloration of the skin and sclera) – occurs when bile acids enter the blood from the gallbladder and settle in the tissues of the body (jaundice)

Problem diagnosis

When the above symptoms appear, in addition to a doctor’s examination, laboratory and instrumental diagnostics are required.

At the medical center “Medline” to the services of patients:

• Clinical blood test – to identify the inflammatory process in the body, in which there is an increase in ESR (erythrocyte sedimentation rate) and the number of leukocytes
• Duodenal intubation is an informative diagnostic test in which a thin tube (probe) is inserted into the duodenum and bile is collected through it for examination in a laboratory. This is how the chemical composition of bile, inflammatory elements (leukocytes and mucus appear), atypical cells in tumor processes are determined.Also, bacterial inoculation of bile on nutrient media is carried out in order to identify the causative agent of infection
• Ultrasound examination of the abdominal organs – this method of examination visualizes the gallbladder, its bend, the thickness of the walls of the gallbladder, the expansion of the common bile duct, the presence of stones, polyps, etc.

Treatment of gallbladder diseases

The drug therapy prescribed in the gastroenterology department of the Medline clinic is complex – taking into account the cause of the disease and pathological changes.There are fundamental principles that are followed here in the treatment of all gallbladder diseases.
Etiotropic therapy – is aimed at completely eliminating the cause of the disease. For this, antibiotics are used for cholecystitis, surgical treatment for gallstone disease, polyps and tumors of the gallbladder.
Pathogenetic therapy – is used to restore the function of the gallbladder (antispasmodics for hyperkinetic type of dyskinesia), reduce the intoxication of the body with cholecystitis and tumors.Enzymatic preparations with bile acids (mezim) are used to improve digestion.
Symptomatic therapy – treatment aimed at reducing discomfort and discomfort, pain relievers (ketanov, analgin) and anti-inflammatory (paracetamol) drugs, antispasmodics (no-shpa, drotaverine) or combinations thereof (noshpalgin, spazmalgon).
Diet. The diet for gallbladder disease is to minimize the harmful effects of food on the functioning of the gallbladder.For this, table No. 5 according to Pevzner is used, which excludes fatty meats and poultry (pork, duck), rich broths (enhances the contraction of the walls of the gallbladder).

It is advisable to eat lean meats (beef, rabbit), poultry (chicken), fish (preferably river fish), dairy products, vegetables and fruits. The process of cooking is also important; you cannot fry or smoke it. All dishes are steamed or stewed.

Food. A very important factor in gallbladder problems is not only what food you can and cannot eat, but also how and when to eat.The most optimal is 5 meals a day in small portions, the last dinner at least 2 hours before bedtime. Snacks on the go and dry food are not allowed.

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