Long-term assistance with gallbladder surgery

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Gallbladder surgery can be successful in treating gallstones , but a significant number of people have adverse symptoms known as post-cholecystectomy syndrome. Adjusting your diet and eating habits can help alleviate these problems. In some cases, a new operation may be required to correct these symptoms. Also, there are differences in outcomes between people who have had gallbladder surgery to treat cancer .

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Benefits of surgery

The number one reason for gallbladder surgery , gallstones, leads to one of the most frequently performed elective abdominal surgeries in the world, namely laparoscopic cholecystectomy (LC). Cholecystectomy is the removal of the gallbladder. In fact, 700,000 laparoscopic cholecystectomies are performed annually in the United States .

A 2019 systematic review found that more than half (60%) of people who had their gallbladder removed did not experience any adverse symptoms after surgery and continued to live normal, healthy lives . The pain caused by the gallstones has completely subsided. Population.

Many of those who experience negative symptoms like indigestion and diarrhea after gallbladder surgery can find relief simply by changing their diet. The study authors note that if you experience any digestive discomfort or problems after gallbladder surgery, it's best to start treatment right away rather than waiting to see if your symptoms improve on their own .

Possible future operations

There are several common conditions and symptoms that can appear after gallbladder surgery, and some may require further surgery. Common conditions that can occur after cholecystectomy include neoplasms or residual gallstones.

Postcholecystectomy syndrome

Having adverse symptoms after gallbladder surgery is called post-cholecystectomy syndrome. Postcholecystectomy syndrome is a general term that refers to the adverse symptoms that follow a gallbladder removal procedure. Postcholecystectomy syndrome includes symptoms:

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

According to a 2018 study, cholecystectomy did not improve symptoms in 40% of those who had surgery. This means that nearly 280,000 people (out of 700,000) do not experience any symptoms after gallbladder surgery each year.

A systematic review of patients with long-term postcholecystectomy syndrome was carried out to guide the management of this population. In this study, gallstones that were not removed at the first cholecystectomy (as well as new gallstones that formed after primary gallbladder surgery) accounted for up to 23% of symptoms after cholecystectomy .

Many people who have symptoms after a cholecystectomy caused by residual gallstones must undergo a second surgical procedure to remove the remaining gallstones. Residual gallstones are usually found in the common bile duct (CBD) .

Gallbladder remnant

Sometimes part of the gallbladder remains during cholecystectomy; This is called the rest of the gallbladder. When a person has a gallbladder remnant, gallstones can continue to form in the gallbladder, requiring a subsequent surgical procedure to remove the rest.

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

Cystic duct stump

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

Sometimes a very small portion of the cystic duct remains, this is called a cystic duct stump. Cystic duct remnant is the term used when the size of the cystic duct after cholecystectomy   greater than or equal to 1 centimeter (0.39 inch).

The cystic duct is about 1.5 inches long. It is the part of the biliary system that allows bile to travel from the liver to the small intestine. The biliary system is a collection of tubular structures called bile ducts. The bile ducts go from the liver to the gallbladder and then to the small intestine (where bile helps digest and absorb ingested fats).

Long-term effects of gallbladder cancer

Another indication for gallbladder surgery is removal of the tumor. A 10-year study looked at the long-term outcomes of people who had surgery for gallbladder cancer .

Some of the people in the study were diagnosed with cancer before undergoing their first cholecystectomy, while others were diagnosed during surgery (during gallbladder surgery). Others were diagnosed after gallbladder tissue (after cholecystectomy) was sent to the pathology lab for examination.

The study authors found that the median overall survival varied depending on when the cancer was diagnosed, for example :

  • Of those who participated in a study in which cancer was diagnosed at the time of surgery (at the time of cholecystectomy) and the cancer was in an advanced stage and considered inoperable (could not be removed by surgery), these Study participants had a median survival of one month.
  • Of the study participants who were diagnosed prior to cholecystectomy, none had undergone medical operations.
  • Among those diagnosed accidentally (as a result of a pathological examination of the gallbladder tissue), the average survival rate was 38 months.
  • Four of the study participants who were accidentally diagnosed underwent a surgical procedure called a radical resection after an initial cholecystectomy. All four were considered curative.

Note that those who had symptoms of jaundice (yellowish tint to the skin and eyes) fared worse in the study than those who had normal bilirubin levels .

Lifestyle adjustments

After gallbladder surgery, long-term care is usually minimal; most people lead perfectly normal lives without a gallbladder because the liver can still produce enough bile to break down dietary fats. The main difference is that instead of just getting a bolus of bile after a heavy meal in people who have undergone a cholecystectomy, bile continually leaks from the liver into the duodenum (the first part of the small intestine).

While this has not been proven by clinical studies, some experts point to the possibility that this continuous flow of bile acids into the small intestine may be associated with symptoms of dyspepsia (indigestion) and may increase the risk of gastritis (inflammation of the stomach). . . ) and can cause duodenal (small intestine) gastric (gastric) reflux. Reflux occurs when the contents of the stomach or bile rise and irritate the lining of the esophagus.

If you have digestive problems, such as bloating or diarrhea, these symptoms should not be long-term, but should go away a few weeks after surgery .

Diet

After gallbladder surgery, it is recommended that you keep a food diary or dietary supplement so that if certain foods or ingredients are causing symptoms, you can take note and avoid those foods in the future. After gallbladder surgery, pay close attention to how your digestive system reacts to the foods you eat. Foods that are often troublesome include:

  • Fatty or fried foods
  • The spicy food
  • Acidic foods

Make sure to include the amount of food you eat in your journal so that you can first try to cut down on problem foods and see if eating less helps before cutting them out of your diet entirely. Again, keep in mind that many of these food intolerances are temporary, so you may want to try reintroducing the problem foods later.

If you have persistent symptoms, it is important to consult with your healthcare provider for any underlying physiological problems that may be causing adverse symptoms, including:

  • Indigestion
  • Swelling
  • Flatulence (gas)
  • Diarrhea

If you experience adverse symptoms, dietary interventions include:

  • Avoid coffee, tea, and other caffeinated beverages.
  • Avoid any foods that make symptoms worse, such as fatty or spicy foods.
  • Gradually increase your fiber intake (such as fruits, vegetables, and whole grains).

Diarrhea

Some people who have had gallbladder surgery have persistent diarrhea. If you have diarrhea, you can ask your doctor if there is a recommended type of medicine (over-the-counter or prescription) .

Get the word of drug information

While you may be under the impression that gallbladder surgery has no long-term consequences, many people experience some form of chronic problems; Forty percent of those observed during the 10-year follow-up had some residual effects .

Often, the residual symptoms of cholecystectomy do not require additional surgery. Lifestyle changes (such as a simple change in diet) are most likely needed. If you experience symptoms after gallbladder surgery, be sure to check with your doctor; In addition to adjusting your diet, it is important to rule out any serious underlying causes.

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