What happens to the body after gallbladder removal?

Author

Srukova Amina Khamishevna

Candidate of Medical Sciences, doctor of the highest category

Surgeon

until May 31

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Cholecystectomy
is an operation to remove the gallbladder. The gallbladder is a hollow organ that serves as a reservoir for bile. Bile is necessary for digestion. It is secreted by the liver, accumulates and concentrates in the gallbladder, from where it enters the duodenum. If the gallbladder is removed, bile continues to flow into the intestines through the bile duct. True, the characteristics of bile change, so after removal of the gallbladder you need to follow a special diet.

If the bile in the gallbladder becomes too thick, stones form. They can be hard, ranging in size from a grain of sand to a ping pong ball. The presence of stones in the gallbladder causes pain and contributes to the development of cholecystitis (inflammation of the gallbladder). Stones can block the bile ducts.

This condition is defined as cholelithiasis.

Unfortunately, in most cases, gallstones cannot be eliminated using conservative therapeutic methods, and the only way to solve the problem is surgery.

How does the body's work change?

Give your body time to adapt

What happens in the body after surgery and how does the digestive system begin to work without a gallbladder? To avoid complications, you need to understand the processes that follow changes in the body.

Adaptation occurs as follows:

• Now bile continuously flows into the intestines, since it has nowhere else to accumulate. Over time, it begins to be produced less.
• Food is now harder to digest
• Soon the body gets used to the changes. Bile is found in smaller quantities in the biliary tract.

What determines the result of cholecystectomy?

We all know that organs are divided into vital ones and those without which we can live. The gallbladder falls into the second category. There are people who live without it from birth, since this organ simply has not formed at all.

Cholecystectomy is not performed without reason. This means that there was some reason for this, or even more than one. For example, poor diet or bad habits.

Naturally, in order to live a long life after surgery, one should abandon the reasons that led to the need for organ removal.

There are a number of factors that affect later life:

• General physical parameters of the patient;
• Age category;
• Accompanying illnesses;
• Experience and professional qualities of the surgeon;
• Rehabilitation therapy;
• Lifestyle before and after surgery.

Consequences of gallbladder removal

At first there may be phantom pain

Removing the gallbladder is not a complicated and common operation that is not worth serious concerns. The body adapts to fully function without the excised organ within 6-12 months.

If a year after the operation no complications or other ailments have arisen, then you no longer have to worry about the absence of a gallbladder. However, you should be prepared for the consequences of the operation:

• The most difficult period is the first weeks after surgery. I suffer from pain, cramps, nausea. Existing gastrointestinal diseases may worsen. You need to get through this time and it will be easier in the future.
• The quality of dissolution of fats and other heavy elements deteriorates, since bile immediately enters the intestines and becomes less concentrated. This means that beneficial substances will become less absorbed by the body. There is a risk of developing diabetes. There may be nausea, vomiting and diarrhea. These symptoms will pass, but it will take time.
• The liver will also suffer at first, as it will have to take over some of the functions of the gallbladder. And since cholecystectomy is most often caused by poor functioning of the filtering organ, fatty hepatosis may even develop. Therefore, you need to follow the diet and other doctor’s recommendations, then over time the liver will adapt without consequences.
• After removal of the gallbladder, women should not plan a pregnancy until the body has fully recovered. It will take at least a year before you can start taking the vitamin complexes that pregnant women need and switch to an appropriate diet.
• Constipation may occur as unconcentrated bile has difficulty digesting fibrous foods. Therefore, it is better to give preference to foods that are easily processed. However, if constipation has already occurred, then you can do an enema. Repeat the procedure no more than once a week.

Indications for cholecystectomy

The main indications for cholecystectomy are:

• acute cholecystitis (inflammation of the gallbladder);
• chronic cholecystitis with repeated exacerbations;
• blockage (obstruction) of the bile duct – usually caused by a stone entering the bile duct.

Gallstone disease (another name for chronic calculous cholecystitis) is considered a relative indication for cholecystectomy. This means that the stones present in the gallbladder do not yet pose an immediate danger, but at any time they can cause inflammation or blockage of the bile duct. To avoid the need for emergency surgery later, the doctor may recommend performing a cholecystectomy as planned, especially if examination of the gallbladder shows the presence of large stones or a significant number of them, as well as changes in its walls and function.

Possible complications

Stick to your diet and don't get sick

In rare cases, the following complications may occur:

• If you do not adhere to the diet, the bile ducts may become inflamed.
• If an infection enters the body, abscesses may appear, and internal organs may become inflamed.
• Bile leakage may occur. This is when bile leaks into the abdominal cavity.
• The walls of the bile ducts may be damaged.

The main task of the patient after surgery is to follow the doctor’s recommendations and clearly communicate his condition during routine examinations. This will help prevent complications or identify them in time.

Benefits of laparoscopic cholecystectomy

• quick recovery after surgery;
• better cosmetic effect;
• reduction of costs for the entire complex of treatment.
• fewer complications (due to more meticulous tissue preparation).

Photo 3: view of wounds after laparoscopic gallbladder removal

Operation laparoscopic cholecystectomy

LCE is characterized by a lack of tactile sensitivity and the transfer of a three-dimensional image into a two-dimensional plane, which requires ensuring a clear image on the screen, which is achieved through the use of high-resolution video optics.

The operation is performed with the patient in the supine position. There are two main methods for performing LCE: French and American, which differ in the location of the operating team members and trocars on the anterior abdominal wall (Figure 1).

Figure 1. Disposition of team members in the French (A) and American (B) LCE methods. S - surgeon, AS - assistant, SN - operating nurse, IT - table with instruments, AS - anesthesia console, DF, SF - monitors

To insert instruments and a video camera, 4 trocars are used (Figure 2).

Photo 4. Location of trocars during surgery

The classic version of laparoscopic cholecystectomy is to remove the gallbladder “from the neck.”

• The first step is to isolate the structures in the area of ​​the gallbladder neck, which includes dissection of the cystic duct and cystic artery. This is achieved by traction of the gallbladder upward through the bottom and Hartmann's pouch, which allows you to gently “pull” the tissue in the cervical area and isolate the duct and artery (using an L-shaped electrode).
• After isolating the cystic artery and duct, they are clipped separately (3 clips for each structure). When isolating the cystic duct and artery, be sure to make sure which structures are planned to be crossed!
• After applying the clips, the cystic artery and duct are intersected. After this, the gallbladder is “cut off” from its bed with mandatory careful hemostasis. The gallbladder is subsequently removed through the largest trocar opening above the umbilicus.

Video: Removal of the gallbladder (treatment of the duct and artery)

The question of the need for drainage of the abdominal cavity during LCE requires an individual approach in its solution.

On the one hand, drainage increases the risk of developing postoperative infectious complications, on the other hand, it allows you to control the surgical area. According to Kriplani AK et al. the frequency of fluid accumulations (bilomas, seromas) after cholecystectomy in the early postoperative period according to ultrasound is 42% without drainage, 26% with passive drainage, 20% with active drainage.

Indications for drainage during cholecystectomy are: acute cholecystitis with “difficult” cholecystectomy (perforation of the gallbladder wall during surgery), increased bleeding of the tissues of the gallbladder bed; risk of bile leakage due to damage to the small bile ducts of the gallbladder bed.

The most important

The key to the success of cholecystectomy for cholelithiasis is the timely implementation of the “sanitation” operation before complications develop in the “cold” period without exacerbation! It is important to pay attention to the symptoms of the disease in a timely manner and consult a doctor promptly!

How to live without a gallbladder? Doctors' recommendations

It is necessary to permanently give up bad habits such as smoking and drinking alcoholic beverages.

Proper nutrition

The first day after the operation you can’t even drink, you can only moisten your lips a little. Then you can only drink and only plain water. Then, for about a month after removal of the gallbladder, you should follow a strict diet.

There are many nuances that need to be taken into account: cooking methods, consistency, temperature of food, frequency of food intake and its volume. After cholecystectomy, a therapeutic diet “table No. 5” is prescribed.

Nutrition rules

Prohibited for use:

• Salo;
• Sausages;
• Animal fats;
• Fat meat;
• Smoked meats;
• Pickles;
• Red fish and caviar;
• Roast;
• Synthetic dishes;
• Alcohol;
• Sauces;
• Sweets;
• Coffee, cocoa, chocolate;
• Floury.

At first you will have to eat boiled pureed vegetables and baked fruits. Over time, the list of permitted products increases. You can add low-fat cottage cheese, kefirs, yoghurts, puddings and casseroles to your diet.

Later, it will be possible to gradually introduce more solid foods into the diet: boiled lean meat, crackers without spices and salt.

After cholecystectomy you have to take a lot of medications, so you shouldn’t overload your body with heavy food. You also need to eat fractionally, that is, often (5-7 times a day), but in small (no more than 200g) portions.

Don't forget to drink enough fluid. However, in no case should it be sweet soda. You need to drink at least two liters of clean water per day. 1-2 glasses half an hour before meals and an hour after meals, half a glass.

There is no way to ignore nutritional recommendations. After all, it was poor nutrition that brought the patient to the surgical table. And now, when the body is still weakened, we do not need complications.

Sample menu

Physical exercise

You will have to give up sports for a while and reduce the load on your abdominal muscles. Especially if the operation was not laparoscopic, but abdominal. However, when you no longer have to worry about the seams, you can and even need to add light physical activity. This is important for recovery.

You can start charging within a month after laparoscopy. The recovery period after traditional surgery will be longer and is determined individually for each person.

Walking is very good for your health. In general, it is advisable to move more. After 1-2 months you can go swimming. Gymnastics for the anterior abdominal wall will also be effective. The benefits will be tangible:

• Prevention of adhesions that may appear after surgery;
• Stimulation of intestinal motility;
• Improves blood circulation, heart and blood vessel function.

You need to get rid of excess weight and try to keep it normal. After all, it is poor nutrition that in 99% of cases leads to problems with the gallbladder and fat accumulation.

And remember that an active lifestyle improves the motility of the digestive organs.

Drug treatment

Common Side Effects of Gallbladder Surgery

Gallbladder surgery can cause a number of side effects that should subside within a short period of time after surgery. If they last longer than a month, you should inform your surgeon.

Classic side effects of gallbladder removal include:

• diarrhea, constipation;
• excessive gas formation;
• flatulence.

If side effects occur, you can talk to your doctor about medications that can help relieve symptoms. Ursodeoxycholic acid is usually prescribed to improve bile fluidity, and symptomatic drugs (laxatives, antidiarrheals, anti-flatulence drugs, etc.). It can also be helpful to keep track of what triggers or intensifies the discomfort and, if possible, avoid these risk factors.

Call your doctor immediately if you have:

• fever began;
• abdominal pain intensifies;
• nausea and vomiting that does not go away;
• jaundice began - yellowing of the skin and sclera of the eyes;
• the wounds are red and/or painful (if a classic rather than laparoscopic cholecystectomy was performed. In the second case, the surgeon does not make any incisions).

Gallstones increase the risk of developing heart disease. In particular, the likelihood of coronary heart disease (CHD) increases by 23%.