Gallbladder removal — cholecystectomy — is one of the most routine surgeries out there, to the point that it's often the first procedure a surgical resident will perform on their own. Many people, on the other hand, don't even know where their gallbladder is or what it is for. It's only natural to want to learn more about gallbladder removal.
Even more, it would be beneficial to understand which problems an unhealthy gallbladder could cause. The question is, should we choose gallbladder removal or alternative treatment? What are the benefits of gallbladder removal surgery, and what are the consequences? There are too many questions with too many different answers. Most of you would like to learn more about convalescence and recovery time after gallbladder surgery, but let’s start with some general facts.
Gallbladder Problems
In conventional medicine, there are different approaches to gallbladder problems, and all carry unwanted risks. The most common treatment has as many as 10% of patients coming out of surgery with stones remaining in bile ducts. The gallbladder is connected to the spleen by nerves, and also closely linked to the liver. Anyone with gallbladder problems or with gallbladder removed should avoid or minimize food that weakens the liver or spleen, such as white flour, white sugar, caffeine, chocolate, and deep fried foods. [2]
According to Traditional Chinese Medicine, one should avoid or minimize consumption of cold food, cold drinks, citrus fruits, tomato, banana and even salads because they weaken the spleen and kidneys.
What Is Gallbladder Removal Surgery?
Alternative names for the same surgery are an open cholecystectomy (performed by making a larger incision to remove the organ), laparoscopic cholecystectomy (minimally invasive, as it is carried out with the help of viewing instruments), or just cholecystectomy.
Gallbladder removal is a surgery that removes an inflamed or obstructed gallbladder, especially if gallstones are causing pancreatitis, or if your doctor suspects that you could have cancer. [3]
A surgeon will perform gallbladder removal surgery, or a cholecystectomy, under general anesthesia, which means the patient is unconscious and pain-free. A doctor most commonly performs gallbladder removal is through four small incisions, with the use of a small video camera, called laparoscope. In laparoscopic surgery, the abdomen is inflated with carbon dioxide to provide more space for the surgeon to work. The doctor identifies the vessels and duct leading to the gallbladder, clips, and cuts, so he can remove the gallbladder is and close the incisions.[3]
In complicated cases, a surgeon may perform an open cholecystectomy. A larger incision is made just below the ribs on the right side of the abdomen, the vessels and ducts going to the gallbladder are identified, clipped, and cut, and the surgeon removes the gallbladder and closes incisions.[3]
When Is The Procedure Necessary?
Gallbladder removal is usually done to treat different gallbladder diseases, gallstones, infection or inflammation known as cholecystitis, gallbladder cancer, and biliary dyskinesia (abnormal gallbladder function).
Risk Factors Of Gallbladder Surgery
The risks of any surgical procedure involving general anesthesia include reactions to medications or problems with breathing, as well as the removal surgery itself. The risks for this surgery specifically include [4]:
- bleeding,
- infection,
- injury to the bile duct.
However, most patients tolerate the procedure well, recover rapidly, and quickly return to their daily routines even without their gallbladder.
Convalescence And Recovery
For open gallbladder removal, most patients need to spend between three and five days in a hospital. For laparoscopic gallbladder surgery, a patient's hospital stay is likely to be shorter, and they will be at home within 24 hours. The outcome of a cholecystectomy is usually good, and symptoms are relieved completely in about 90% of the patients who undergo gallbladder removal.[3]
Your gallbladder removal recovery period depends on the mode of surgery employed:
- laparoscopic cholecystectomy patients need approximately two weeks to return to their normal daily activities,
- while those who had open gallbladder removal may require as much as six weeks.
Injuries from a new procedure to remove gallbladders are lower than previously reported in the media. The higher injury rates that media previously reported were based on inaccurate inferences of bile duct injuries from hospital administrative records. Media reports had wrongly indicated the rate of bile duct injury from both laparoscopic and open surgical gallbladder removal has tripled from 0.3 percent to 0.9 percent from 1991 to 1995.[5]
However, studies do indicate that approximately 30 percent of people who have had their gallbladder removed continue to suffer from diarrhea, even once the immediate recovery period has passed. While people suffering from gallbladder disease are routinely advised to adhere to a low-fat diet, there are no such restrictions on those who have already had a cholecystectomy. Despite that, many find that they can prevent diarrhea and abdominal discomfort by following a cholecystectomy diet. The cholecystectomy diet is a low-fat diet in which patient should avoid processed and spicy foods, and eat smaller meals more frequently. Following this diet will help you during your recovery period and beyond.[6]
Alternatives To Gallbladder Surgery
An alternative to surgery is a gallstone removal by chemical dissolution, the so-called gallbladder flush. This traditional European folk remedy recommends the use of olive oil and lemon juice to flush the gallstones. A primary concern is that if the stones are too big, they may not easily come out or may even get stuck on the way out. [7]
If your problem is gallstone, you should know that traditional Chinese medicine recommends the use of Gold Coin Grass. This plant is supposed to crush and soften the stones so that they will come out slowly. The problem is that this tends to take a relatively long time, but the upside is it does not cause any side effects.
Problem With Gallstones
When gallstones exist, the gallbladder cannot contract efficiently, and only stones in the front area of the gallbladder can be pushed out in the first flush. Then the stones from the back area would slowly move forward and may cause repeated problems.
Flushing is a process used to clean out all the stones, and it needs three to four repeats to achieve results. The patient should repeat the flush until hardly any stone comes out even though a patient has had a good flush. The weaker a gallbladder's contraction, the more flushes will be needed to push out all the stones. A good flush means that all the loose stones are out and the patient feels good for at least a few days. The remaining stones are packed ones, which should be allowed to loosen up and get ready to come out. The interval between good flushes should be 1-2 months, because repeating the flush too soon after a good flush may be a waste of effort as the packed stones are not ready to come out yet. Once the stones form, the gallbladder tends to be sluggish.[7]
There is a possibility that the new stones form again. Therefore 1 to 2 flushes a year is recommended for maintenance. The actual problem if the gallbladder loads with stones, is that there is limited space in the gallbladder to store the bile. The bile, produced in the liver, stays in the liver and leads to liver congestion, which could lead to more problems.
Another problem is that bile produced in the liver has to flow down to the gallbladder to push out the stones with the help of gallbladder contraction, assisted by lemon or grapefruit juice. If the liver is congested, bile flow is restricted, so as a result, there is insufficient bile in the gallbladder to push the stones out.
After Gallbladder Surgery Is Done
To understand this article we have to know that the gallbladder stores, concentrates and secretes bile, which body produces in the liver. Most people know that bile in the intestine is necessary for the digestion and absorption of fat and is also important for lubricating the intestinal wall. Once the gallbladder is removed, the bile has lost its storage space and tended to accumulate in the liver, so the result is a reduced bile flow because the liver does not contract to squirt the bile into the intestine as a healthy gallbladder does. The reduced bile flow usually causes problems such as indigestion, constipation, or diarrhea. When the accumulated bile becomes congested in the liver, it weakens liver functions.[1]
This could even lead to depression, which is, according to Chinese medicine, a sign of blocked liver energy. The combined effects of liver congestion and intestinal sluggishness may also cause a sleep disorder, insomnia, or bad breath. Furthermore, the reduced bile flow could weaken the spleen and pancreas. In some cases, this side effect is so strong that even may result in diabetes.[8]
Auto-immune diseases and allergies may also be the result of gallbladder removal because they are often caused by a weak liver and spleen.
Other health problems that patients may experience after gallbladder removal include itchy skin, arthritis, or anemia, where allergy and arthritis are associated with a weak liver and spleen. Itchy skin is usually caused by weak spleen as well if inflammation is involved. If there are no rashes, it may be caused by bilirubin, which is one of the major components in bile crystallizing under the skin. When excessive bilirubin is in the blood due to excessive bile carried to blood circulation from the liver, it may crystallize. This substance crystallizes because it has low solubility in blood. Excessive bile in blood is usually the result of a stagnant bile flow caused by liver congestion or some blockage, as explained earlier. In this process, it is important to understand that our red blood cells live about 100-120 days. The worn-out cells are destroyed by the spleen or the liver, so when the spleen and liver are healthy, the broken down products would be recycled to produce new red cells. Weak liver and weak spleen that have poor recycling capabilities may lead to anemia.
In these cases, the only relief is to stimulate the bile flow.
Until now, a combination of taking Chinese Bitters in the morning and Coptis at night showed best results for patients who already had gallbladder surgery. This combination is supposed to help these patients relieve symptoms related to gallbladder removals, such as sleep problems and difficulty with a bowel movement.
It is common for people who have had their gallbladder surgically removed to have gallstones in the liver.
When the bile that is produced in the liver cannot be stored in the gallbladder anymore, it tends to get congested in the liver. When the bile is stagnant in the liver for too long, it becomes too concentrated, so then cholesterol and bile pigments may crystallize. This process leads to the formation of stones in the liver, similar to what happens in the gallbladder.
Highly processed and fat-rich diet is, along with obesity, one of the main risk factors for gallstones. Due to an excess of cholesterol, many people will make dietary changes to avoid discomfort after their cholecystectomy. Therefore, it is not uncommon for individuals who have had their gallbladder removed to lose weight spontaneously. However, it is also important to keep in mind that people who experience trouble with weight loss after gallbladder removal should always seek to find the cause of their weight gain by consulting their doctors, especially if they have indeed made lifestyle changes that should logically have caused them to lose weight following their cholecystectomy.
Pale Yellow Diarrhea After Gallbladder Surgery
One of the most common post-gallbladder surgery side effects is diarrhea. As mentioned before, the function of the gallbladder is to store bile, which contains digestive salts made by the liver. During meals, the gallbladder releases the stored bile salts into the intestine to help with digestion, and after food is digested and absorbed in the intestine, the bile salts are also reabsorbed and recycled. Following a cholecystectomy, the liver must make more bile salts, and more are released between meals. This is necessary because there is no place to store these substances. The problem is that an increased amount of bile salts can sometimes overwhelm the intestines' capacity to absorb them. In this case, the unabsorbed bile salts can prompt the colon to secrete fluids, leading to diarrhea. This scenario is benign and it does not get worse, but each patient should be aware of it. Interestingly, some patients who were prone to constipation before their surgery are happy with this side effect. Also, certain medications, such as Questran, that bind the excess bile salts can be prescribed to patients who experience severe diarrhea.[1]
However, if a pale yellow diarrhea occurs soon after gallbladder surgery, other factors must also be considered. These include new medications that patient may be taking or an infection that may have been acquired in the hospital. If this happens, the patient should discuss these symptoms with the doctor, who will perform appropriate diagnostic testing.[9]
There are also some other gastric symptoms common after a cholecystectomy, often lumped together under the term “post-cholecystectomy syndrome.”
The most common symptoms reported by gallbladder patients include [9]:
- right-sided abdominal pain,
- flatulence,
- bloating,
- nausea.
The reason for these symptoms is unclear. They have no relation to the surgical procedure. Often they were present before the operation and may have been the reason that diagnostic tests and diagnosis were done in the first place.
They may have been mistaken for gallbladder symptoms, which leads to the operation, but since gallstones are so common, finding them does not necessarily mean that they are the cause of a patient's symptoms. That is why the removal of the gallbladder may not eliminate the problems after all. In some cases, these are new symptoms and may indicate a disease in another organ that must be investigated by your doctor.
General Effects Of Gallbladder Surgery
The gallbladder removal can be a shock to your system, but generally, there are no long-term restrictions on your diet after gallbladder removal. However, some patients do complain of increased gas or bloating after meals for up to several weeks after their gallbladder surgery. In most cases, these changes are temporary and will improve within a few weeks of having the operation. If you have had major surgery involving the removal of other organs such as the pancreas, you may have problems digesting your food, and you may not feel like eating much; eating small meals often may seem easier than having three large meals a day.[9]
Ii is important to take care of your bowels after gallbladder surgery. The fact is that 20% of people who have their gallbladder removed experience diarrhea afterward, as the small intestine absorbs a lot of substances that should not be there in such amounts. That is why the extra bile passes into the large intestine or colon. The bile holds water in the large bowel, causing loose and watery stools. After the gallbladder has been taken out, the patient's stools tend to stay in the intestine for less time, which is the reason the patient has more frequent bowels after gallbladder surgery. Diarrhea will improve with time, but unfortunately, it can last for many years, which can make everyday life more difficult.
Being continuously worried about having a bowel-related accident when a person is out can be a great strain, but some things may help. Individuals with this problem could eat a high fiber diet to absorb excess water and make bowel motions bulkier. It’s recommended to consult your doctor which could prescribe anti-diarrhea medicine to slow down the excessive bowel movement.
Some experts recommend avoiding food that can make diarrhea worse, such as tea and coffee, dairy products, spicy and fatty foods. Wearing a small pad might help you prevent embarrassing moments in public and help you feel confident.