A person who is about to undergo an operation to remove the gallbladder must imagine in advance what consequences are possible in later life, and how to avoid them.

It cannot be considered that after the operation disability threatens - gallbladder enough important element digestive system but not vital. The body is designed in such a way that, losing such an organ for some reason, it compensates for its functions. But it is necessary to take precautions to avoid complications.

Pain after removal of the gallbladder is typical for the first postoperative days. If an open cholecystectomy was performed, the main trouble of early recovery period- pain from the wound. Regardless of the type of operation, the patient is worried about strong physical discomfort - surgical intervention, even of a high professional level, disturbs the internal organs, affecting their work. The consequences of anesthesia are being felt. Possible dizziness, clouding of consciousness, weakness, vomiting. In addition, after surgery, patients suffering from acute complicated cholecystitis are haunted by phantom pains - it seems that the gallbladder hurts, which is not there.

Postcholecystectomy syndrome

Contrary to popular belief that after the removal of the gallbladder, there must necessarily come quick relief painful condition, in reality, the occurrence of various problems. A few days after the operation, the appearance unpleasant symptoms. There are disturbances in the work of the intestines: flatulence, diarrhea, bloating, cramps, constipation. You may experience dry mouth, nausea, heartburn, sour or bitter belching, pain in the stomach, cramps.

The combination of these signs is commonly called postcholecystectomy syndrome. Some of them are of psychological origin and are caused by the anxious expectation of deterioration in health, while others are quite objective.

To adapt to the absence of the gallbladder and stabilize the function of the digestive system, the body needs time and the right lifestyle. To cope with pain in the postoperative period and help digestion, antispasmodics, probiotics, and enzymes are prescribed. Bile in the absence of a gallbladder does not process incoming food into necessary measure. The drugs are selected by the doctor, self-medication can cause allergic reaction or aggravate symptoms.

The condition of the sutures applied after the operation also requires attentive attitude. It is necessary not only to change the bandages in time, but also to take care of yourself, avoid sudden movements, tilts, do not lift heavy things, do not strain.

Possible complications

The first days the patient is under the supervision of a doctor, after being discharged home, you need to control your well-being on your own.

Signs such as subfebrile temperature(about 37 ° C), which does not pass for several days, severe spastic pain in the abdomen on the right, resembling colic, vomiting, liquid stool, yellowing of the skin indicate possible complication. In such cases, a doctor should be contacted immediately.

1. Poorly performed operation or its conduct emergency indications without prior preparation can cause the development of biliary peritonitis. Bile enters the abdominal cavity from the ligated ducts or with the development of obstructive jaundice.
2. TO undesirable consequences operations include adhesive processes. The formation of adhesions occurs due to a violation of the integrity of tissues internal organs during surgical intervention due to growth connective tissue. The main symptoms of adhesions: a feeling of tightness inside, stabbing pains. Expressed adhesive process may require a second operation.
3. A common complication after gallbladder surgery is a cicatricial hernia. The strangulated area of ​​the intestine or omentum protrudes under the skin in the form of a swelling or pouch. For some time, a hernia may not cause inconvenience and be painless, but prolonged tissue infringement leads to circulatory disorders, inflammation, advanced cases to the development of necrosis or peritonitis. At the first sign of a hernia, it is necessary to perform a hernioplasty. A special mesh is placed under the skin directly on the site of the infringed organ to prevent recurrence. There is no other treatment than surgery for this disease. The risk of hernia formation is high in people with overweight, flaccid saggy abdominal muscles or neglecting the requirements for a ban heavy loads. For prevention, they are shown to wear a bandage for several months after the operation.
4. Violations of intestinal motility, which are inevitable in the absence of a gallbladder in the body, often cause persistent constipation, especially if not adhered to. healthy eating and regularly snack on fast food, sandwiches or muffins. If a lack of movement is added to this, the situation may well be complicated by hemorrhoids. The veins of the rectum will be constantly overflowing with blood, lose their tone and will constantly remind of themselves with burning, bleeding, and prolapsed nodes.

The absence of the gallbladder does not affect the amount of bile produced. The only thing that changes is its circulation. If earlier the bile produced by the liver was stored in a bladder, the walls of which absorbed excess moisture, and dosed into the intestines during the digestion of food, now this liquid fills the ducts and can be in the intestines after hours. Bile acids, passing through the intestines, are not reused and are excreted. In addition, excessively liquid immature bile protects the intestines from pathogenic microbes worse. Such disorder provokes the development of a number of violations. digestive tract: dysbacteriosis, bloating, flatulence, diarrhea, changes in intestinal microflora.

Heartburn after gallbladder removal is not uncommon. Under the action of aggressive bile acids, the structure and integrity of the mucous membranes of the stomach and intestines can change. Biochemical and physiological changes bile secretion provoke the development of colitis, gastritis, enteritis, pancreatitis. An exacerbation of pathologies is likely, if they are in the anamnesis.

Already in the first days after surgery, most patients experience an expansion of the common bile duct due to increased bile flow and the lack of a place for its reservation.

Cholecystectomy is a forced measure that saves a person from the threat of becoming disabled or fatal.

If the operation was performed due to cholelithiasis, it should be remembered that the main cause of stone formation is the lithogenicity of bile, which persists after surgery. This means that stones can form and deposit in the intrahepatic ducts, the common bile duct, which threatens the development of choledocholithiasis.

In order to prevent stone formation and reduce the lithogenicity of bile, Ursosan or Hepatosan are prescribed - drugs based on ursodeoxycholic acid. Mandatory lipotropic diet - the use of products that reduce cholesterol in the body. These include egg whites, olive oil, lean fish, green vegetables, fermented milk drinks.

Lifestyle after surgery

Diet after surgery is not a temporary phenomenon, but a way of life. In the first two months, she is strict. Food is taken at the appointed time, in small portions, ideally every 2.5 hours. We will have to say goodbye to gastronomic delights and switch to mashed boiled meat and fish, soups with vegetable broths, kissels, cereals. Eliminate animal fats and sugar, alcohol. Preferred for drinks mineral water without gas - dining room and medical, herbal teas. With insufficient pancreatic function, it is allowed to take enzymes. Any violation of the regimen can cause exacerbation of pancreatitis or peptic ulcer. Over time, you can expand the list of products by gradually introducing salads from raw vegetables, fruit. You will have to adhere to food restrictions for the rest of your life.

FROM in a sedentary manner life also needs to be said goodbye. In order to avoid the formation of adhesions, hernias, constipation, hemorrhoids, it is necessary to move to improve the digestive processes. Physical activity should not be power, but aerobic, that is, stimulate blood circulation, maintain the tone of the cardiac system. It is useful to walk a lot, skiing, cycling, swimming.

With time healthy habits help the body recover properly.

Any operation associated with the removal of an organ usually raises a lot of questions. The most exciting: how will life change after the removal of the gallbladder? Patients are also interested in how long they live after such an operation.

To understand this, it is necessary to familiarize yourself with information about the role and significance of this human organ.

Functional features

The worries and anxiety of patients are not unfounded, because the gallbladder bears a great responsibility for the entire digestive process. Its function lies in the ability to accumulate bile, which comes from the liver. In it, it is concentrated to the required state and, if necessary, is excreted through the bile ducts into the intestine, where it participates in the processing of food components.

The outflow of bile from the bladder into the stomach begins immediately after the food bolus enters it, where it breaks down fats and assimilates useful elements.

A feature of the process of bile production is its continuity, regardless of food intake. Its unclaimed part accumulates in the bladder, where it remains until the next digestive act.

It seems that without this small but rather important organ, the further life of a person is impossible, since in its absence the activity of the digestive system is disrupted. But situations arise when the need to remove it is caused by a real threat to the patient's life.

Reasons for deletion

The most common reason for surgery is cholelithiasis. Calculi can form not only in the accumulative organ itself, but also in its ducts.

The danger of their presence lies in the fact that they interfere with the free passage of bile and thereby provoke inflammatory processes, deformation of the bladder, its blockage.

This eventually leads to rupture of the organ, peritonitis and, in especially severe cases, becomes the cause lethal outcome. Therefore, with such a diagnosis, a laparoscopic operation is recommended to remove the bladder along with the formed stones.

Advantages and disadvantages of the operation

In addition to surgery, there are conservative methods treatments, leading among which are the dissolution and crushing of stones. Their disadvantage is the duration of the course and the high probability of recurrence of the formation of calculi.

At the same time, laparoscopy modern methods, held in short time painless and does not require long postoperative rehabilitation.

After the operation, the patient is discharged home after 3-5 days. This is due to the lack of the need to heal a large suture. For a laparoscopic operation, only 3-4 punctures are made, and the patient can already get out of bed 5-6 hours after it.

Changes taking place in the body

Cutting out the bladder necessitates the restructuring of the biliary system. The storage function is shifted to ducts, which can accommodate much less. To avoid stagnation of bile in them, the patient will long time follow a diet.

But you shouldn't panic. After some time, with the right approach to nutrition, which promotes a regular outflow of bile, the ducts will expand and nothing will remind you of the operation.

To return to the old way of life, you should strictly follow the main requirement of the diet. It consists in frequent and fractional food intake, which makes it possible to realize the bile produced by the liver.

It should be borne in mind that its constant intake into the duodenum, caused by the absence of bile, provokes irritation and can cause indigestion. This condition is called postcholecystectomy syndrome.

After operation

It is not uncommon for those who have been operated on to become depressed thinking about how to live with a disabled gallbladder. To eliminate the state of confusion, you should read the tips suggesting the implementation of some rules.

You should not lose heart, because compared to the excruciating attacks and the threat to life that they represented, these rules do not bring any trouble.

How to behave in the early days

Compelled bed rest after anesthesia is no more than 6-7 hours. Longer stale should not be in order to avoid the formation of postoperative adhesions.

Movements should be simple, not associated with great physical exertion. This is a calm movement within the chamber.

About nutrition

In spite of good condition patient, you should strictly follow the instructions regarding the use of food. They are the following:

Portions are small, you should eat slowly, chewing food thoroughly. This will help the digestive system gradually get used to the new situation. Bile during this period does not have sufficient concentration and comes involuntarily.

After the hospital

You should not worry if there will be some time in the puncture area. slight discomfort. It will disappear when damaged tissue heal. But in the presence of intense pain syndrome you need to see a doctor.

To avoid infection and irritation on the skin in the area of ​​punctures, underwear is used soft, delicate. Until the stitches are removed exercise stress contraindicated, since the formation of a postoperative hernia is possible.

Behavior during the recovery period

Life without a gallbladder goes on. Rehabilitation after elective laparoscopic surgery is not difficult. The main task of the patient is to help the body cope with a complex problem.

It consists in the formation of the replacement function of the bile ducts. They have to take over the regulation of the flow of bile into the stomach.

Follow your gastroenterologist's instructions for compliance diet food will be central to this process.

During rehabilitation period it is necessary to pay attention to the important requirements that contribute to the rapid and full recovery vitality:

1. It is necessary to use table number 5 as the main diet, excluding fatty, fried, spicy dishes.
2. Particular attention should be paid to the condition of the chair. Defecation should be regular, the consistency of bowel movements should be soft.
3. Not recommended for two months after surgery sports activities and strenuous physical activity. For example, it is strictly forbidden to lift or carry objects weighing more than 3 kg. Physiotherapy, walking on fresh air, a short easy run will become good helpers in the normalization of the biliary process.
4. In the field intimate life sexual intercourse is excluded for a month.
5. It is undesirable to plan a pregnancy within one year, since restriction in certain types of food can adversely affect the development of the fetus.

Reception vitamin complexes, agreed with the attending physician, will accelerate the final recovery and significantly improve the quality of life. The most effective vitamins are Supradin, Centrum, Vitrum.

Possible Complications

Surgical removal of an organ has its pros and cons. Sparing the patient from painful attacks, it leads in some cases to undesirable consequences, among which:

These signs are temporary. They pass within one to two months, subject to strict adherence to the diet and other recommendations of the doctor.

More serious complications may occur during the operation.. It's trauma blood vessels or nearby internal organs. Undesirable phenomena are eliminated directly during it or with repeated intervention.

Nutrition Features

This will be facilitated correct mode nutrition, providing 5-6 one-time admission food at the same time. As well as the exclusion from the diet of products that provoke an increase in the outflow of bile.

The use of diet number 5 provides for the following rules:

1. For cooking, food can be stewed, boiled, baked, steam cooked.
2. The amount of food consumed at one time should be small.
3. Break between meals - no more than 3 hours.

The rules are simple to apply, but ensure the normal flow of bile and the functioning of the digestive system.

Contraindicated foods

In order not to provoke stagnant processes or, conversely, not to cause excessive bile secretion, the following types of food should be discarded:

• fatty meats and fish;
• meat semi-finished products;
• sausages and products from it;
• fat cream, cottage cheese;
• raw vegetables;
• fresh bakery and confectionery products;
• coffee, chocolate, alcoholic beverages.

It is necessary to completely exclude marinades, smoked meats, spicy seasonings, fried foods from the menu.

allowed food

The following useful products saturate the body with useful microelements and vitamins:

• chicken, rabbit, turkey meat;
• low-fat fish dishes;
• vegetable soups;
• cereal dishes;
• milk and dairy products with a low percentage of fat;
• fruits and berries, but not sour;
• jam, honey;
• butter, no more than 20 g per day;
• vegetable oil - 30 g.

The dietary table can be diversified by cooking steam omelettes, meatballs, meatballs, beetroot, pumpkin or carrot puree, fruit mousses, casseroles.

This diet is followed throughout the year. But in order to keep the digestive system in proper order, it is advisable to continue it further with the gradual introduction of new dishes to the menu that do not cause discomfort.

About the most important

Naturally, everyone is concerned about how the removal of an organ affects life expectancy. Statistics show that a person can live without this organ for a long time. Unless, of course, there are other serious diseases.

The conclusion is unequivocal: the operation to remove the bladder is not the reason for the reduction of life span. But to promote him such bad habits, how:

• alcohol abuse;
• smoking;
• lack of motor activity;
• excess weight.

These factors shorten a person's age and without the presence of any pathologies. That is why it is so important to healthy lifestyle life.

It is not possible to name exact dates the end of the recovery processes in the body. It all depends on individual characteristics the patient, his desire for recovery and compliance with all recommendations according to the requirements of specialists.

A person who has undergone surgery to remove the gallbladder must follow a diet for the rest of his life, since he does not have a reservoir where bile used to accumulate. After such an operation, you need to strive to ensure that bile does not stagnate in the biliary tract. The only way to achieve this is to eat more often. In no case should bile stagnation in the biliary tract be allowed, since the process of stone formation may begin. Therefore, it is necessary to eat at least five times a day, in small portions, preferably at the same hours. Food must be chewed thoroughly. All food should be eaten warm.

It is important to remember that fried foods are contraindicated, since the process of frying retains substances that affect the secretion of digestive juices and irritate the mucous membrane. gastrointestinal tract. Such activation of the digestion process is detrimental in the absence of a gallbladder. Therefore, food must be steamed, stewed or boiled.

What foods can be eaten after gallbladder removal (cholecystectomy)?

1. It is necessary to introduce vegetable and milk fats into the diet, as they help the rapid discharge of bile. For breakfast and dinner, sour-milk products are optimal, as well as cottage cheese dishes: puddings, casseroles, cottage cheese pancakes, cheesecakes. But they need to be filled with fat-free sour cream. Diversify morning and evening menu can be omelettes and soft-boiled eggs.

2. For lunch, first courses should be cooked only on weak meat or vegetable broths, while adding various cereals. It is better to give preference to vegetable broths. Main courses are prepared from lean beef or from chicken meat. Recommended also lean fish 2 times a week, especially sea, which promotes the absorption of fats.

3. Since fats are actively involved in all metabolic processes, then it is impossible to do without them. Therefore, it is necessary to use vegetable fats and butter. Flaxseed oil is very helpful.

4. Bran is great.

5. Bread is better to use yesterday, dried.

6. From seasonings, greens are very good, Bay leaf, turmeric, which has medicinal properties.

7. When the gallbladder is removed, the diet should contain a variety of cereals (buckwheat, barley, rice, oatmeal), vegetables (especially carrots and pumpkin), fruits and berries, with the exception of sour ones. Watermelons and melons, which have a diuretic effect, are also useful to use, as they remove from the body harmful substances and toxins. For dessert, you can eat honey, marshmallows, jam, jam, marmalade, but in small doses. Sweets can be replaced with dried fruits: dried apricots, prunes.

What foods should not be eaten with a removed gallbladder?

1. First of all, these are the products that irritate the mucous membrane of the gastrointestinal tract. These include a variety of spices, onion, garlic, radish, radish, mushrooms. Meat, fish and mushroom broths, spicy, sour, marinades and pickles are also contraindicated.

2. The amount of enzymes in the bile that promote the digestion of fats decreases after removal of the gallbladder. Therefore, it must be completely excluded from use. lard, beef and mutton fat, fatty meat, as well as all kinds of sausages and sausages, because the substances in them disrupt the circulation of bile.

3. Sweets, cakes, pastries, sparkling water.

4. Those products that contain a large number of coarse fiber: beans, peas, wholemeal bread, etc.

5. You can not use sauerkraut because it causes fermentation.

6. Cold foods as spasm can occur biliary tract(ice cream, aspic, etc.).

So, eliminating from your diet listed products, you will avoid unwanted consequences.

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Gallbladder 06.08.2013

Dear readers, today we continue our conversation with you in the heading. There are many blog posts on this topic. It all started with the fact that I shared my experience, I also live without a gallbladder for almost 20 years. And then there were questions from readers. There were so many of them that I asked the doctor Evgeny Snegir to help me and comment on the blog, answer your questions and continue to talk about topics that bother you. Today we will talk about the consequences of gallbladder removal. I give the floor to Evgeny Snegir, a doctor with extensive experience.

Most often, surgery to remove the gallbladder results in full recovery sick. Compliance with diet therapy during the first year after surgery allows you to reliably adapt the digestive system to the changed conditions of functioning, and the person begins to live a full life in the future. healthy life. However, there are exceptions to every rule. IN postoperative period for a number of reasons, unpleasant symptoms may appear, the consequences of gallbladder removal.

Consequences of removal of the gallbladder. Postcholecystectomy syndrome

All the consequences of gallbladder removal are united in one term - postcholecystectomy syndrome. Let's talk about this in more detail. Let's give a definition.

Postcholecystectomy syndrome is a group of diseases associated directly or indirectly with the operation to remove the gallbladder, as well as diseases that progress as a result of the operation. Let's try to figure out this problem together.

So, the operation is performed, and the patient with bright thoughts expects the cessation of the symptoms that tormented him before. However, some time after the operation, the condition worsens again: abdominal pain, upset stool, bloating, general weakness, nausea or vomiting may disturb, sometimes jaundice even reappears. Often patients complain of bitterness in the mouth after removal of the gallbladder. A sick person asks a doctor with a legitimate question: “How so? I came for an operation to get rid of the problems that bothered me, the operation was performed, the gallbladder was cut out, the consequences do not please me, the problems have not gone away, I again have the same story. Why is it so?

All these questions are understandable and legitimate. A doctor should help, not harm, by his actions. However, not everything is in his power. Statistical analysis of problems arising after operations shows that only a small number of patients are concerned about symptoms directly related to the absence of the main function of the gallbladder in the body (bile reserve).

Basically, people complain about problems that arise in connection with diseases of the hepatoduodenopancreatic zone, i.e. diseases of the liver, pancreas and duodenum. Therefore, applied in given time the term "postcholecystectomy syndrome" is subjected to harsh criticism by many clinicians, as not reflecting the causes and essence of the suffering of patients. But the term has developed historically, and everyone uses it for the convenience of professional communication.

So, today, under the term "postcholecystectomy syndrome", depending on the clinicians who use this concept, the following postoperative problems can be combined:

• all pathological changes that occur in the body after removal of the gallbladder;
• relapses hepatic colic due to an inferiorly performed operation, the so-called true postcholecystectomy syndrome. At the same time, in separate group Complications due to errors made during cholecystectomy and associated with lesions of the biliary tract are distinguished: the remaining stones of the common bile and cystic ducts, post-traumatic cicatricial stricture of the common bile duct, the remaining part of the gallbladder, pathologically altered stump cystic duct, cystic duct stone, long cystic duct, neurinoma of the scar area and foreign body granuloma;
• complaints of patients associated with diseases that were not recognized before the operation, which arose in connection with an inadequate examination of the patient, re-formation of stones.

postcholecystectomy syndrome. Causes

Damage to the extrahepatic biliary tract

According to some researchers, the removal of the gallbladder leads to an increase in the volume of the common bile duct. They found that with an unremoved gallbladder, the volume of the common bile duct reaches 1.5 ml, 10 days after the operation it is already 3 ml, and a year after the operation it can reach as much as 15 ml. The increase in the volume of the common bile duct is associated with the need to reserve bile in the absence of the gallbladder.

1. Disturbing symptoms can be caused by choledochal strictures, which can develop as a result of trauma to the common bile duct during surgery or the necessary drainage in the postoperative period. Clinical manifestations similar problems would be jaundice and recurrent inflammation of the bile ducts (cholangitis). If the lumen of the common bile duct (choledochus) is not completely obturated, then symptoms of bile stasis (cholestasis) will come to the fore.

2. Another reason for the persistence of pain after surgery may be. At the same time, true stone formation is distinguished, when stones form again after the operation, and false, when stones in bile ducts were not recognized during the operation and simply remained there.

It is believed that false (residual) stone formation is most common, but again stones in the bile ducts can form only when there is a pronounced stagnation of bile in them, associated with the formation of cicatricial changes in the terminal (final) part of the common bile duct. If the patency of the bile ducts is not broken, then the risk of re-formation of stones is extremely low.

3. A long stump of the cystic duct can also be the cause of the development of pain. Its increase, as a rule, is the result of cicatricial changes in the final (terminal) part of the common bile duct. There is a violation of the outflow of bile and biliary hypertension, leading to lengthening of the stump. Neurinomas, stones can form at the bottom of the stump, it can become infected.

4. rare cause Pain is a choledochal cyst. The most common aneurysmal expansion of the walls of the common bile duct, sometimes the cyst can come from the side wall of the common bile duct in the form of a diverticulum.

5. One of serious complications cholecystectomy is cholangitis - inflammation of the bile ducts. Inflammation occurs in connection with the upward spread of infection, which is facilitated by the phenomena of stagnation of bile (cholestasis), due to a violation of the outflow of bile through the ducts. Most often, this problem is caused by the stenosis of the terminal section of the common bile duct, which we have already considered, and multiple stones of the extrahepatic ducts.

Sphincter of Oddi dysfunction

The sphincter of Oddi is a smooth muscle located in the large duodenal (vater) papilla, located on inner surface descending part of the duodenum. The common bile duct and the main pancreatic duct (main pancreatic duct) open on the major duodenal papilla.

Violation of the sphincter of Oddi leads to changes in the major duodenal papilla, thereby disrupting the activity of the pancreas, cholangitis or obstructive jaundice occurs.

Most studies confirm the fact that after the removal of the gallbladder, the tone of the sphincter of Oddi temporarily increases. This is due to the sudden elimination of the reflex influence of the gallbladder on the sphincter. Such is the story.

Liver disease

It has been proven that cholecystectomy leads to a decrease in dystrophic phenomena in the liver and significantly reduces the syndrome of cholestasis (bile stasis) in half of the operated patients 2 years after the operation. In the first six months of the postoperative period, on the contrary, there may be an increase in bile stasis in the extrahepatic bile ducts, this happens, as we already understood, due to an increase in the tone of the sphincter of Oddi.

The cause of malaise in the postoperative period may be concomitant severe liver dystrophy - fatty hepatosis, which is detected in 42% of patients undergoing surgery.

Bile passage disorders

It is quite understandable that the absence of a gallbladder deprives the body of a reservoir for collecting bile. In the gallbladder, bile was concentrated during the interdigestive period and released into the duodenum as food entered the stomach. After removal of the gallbladder physiological mechanism passage of bile is disturbed. However, violations still persist. physical and chemical composition bile, leading to its increased lithogenicity (ability to stone formation).

Uncontrolled flow of bile into the intestines when it changes physical and chemical properties disrupts the absorption and digestion of lipids, reduces the ability of the contents of the duodenum to lyse bacteria, inhibits growth and development normal microflora intestines. Increased bacterial contamination of the duodenum, which leads to metabolic disorders bile acids, leading to damage by the products of their decay of the mucosa of the small and large intestine - this is precisely the mechanism for the development of duodenitis, reflux gastritis, enteritis and colitis.

Diseases of the pancreas

Gallstone disease can also lead to diseases of the pancreas.

It has been statistically proven that in 60% of patients, the removal of the gallbladder leads to the normalization of its function. So, by the 6th month after the operation, the normal secretion of trypsin (pancreatic enzyme) is restored, and after 2 years, blood amylase indicators are normalized.

However, long and severe course GSD can lead to irreversible changes in the pancreas that can no longer be corrected by removal of the affected gallbladder alone.

postcholecystectomy syndrome. Symptoms. clinical picture.

The clinical picture is just determined causal factors causing postcholecystectomy syndrome.

1. Patients complain of pain in the right hypochondrium and in the upper abdomen (epigastrium). Pain can radiate (give) to the back, right shoulder blade. The pain is mainly associated with an increase in pressure in the biliary system, which occurs when there is a violation of the passage of bile through the bile ducts.

2. Jaundice may develop.

3. Skin itching

4. Dyspeptic phenomena (digestive disorders): a feeling of bitterness in the mouth, the appearance of nausea, flatulence (bloating), unstable stools, constipation, diarrhea.

How is postcholecystectomy syndrome diagnosed?

If the above complaints appear after the operation, the doctor may prescribe the following types research.

1. Laboratory research

Biochemical blood test: determination of the level of bilirubin, alkaline phosphatase, gamma-glutamyl transferase, AST, ALT, lipases and amylases. The most informative biochemical analysis blood during a pain attack or no later than 6 hours after its end. So, with dysfunction of the sphincter of Oddi, there will be a two-fold increase in the level of hepatic or pancreatic enzymes within the specified period of time.

2. Instrumental Research

ultrasound abdominal cavity, magnetic resonance cholangiography, endoscopic ultrasound procedure. The "gold standard" for diagnosing postcholecystectomy syndrome is endoscopic retrograde cholangiopancreatography and manometry of the sphincter of Oddi.

postcholecystectomy syndrome. Treatment.

I. Postcholecystectomy syndrome . Diet. We start with diet. Diet number 5 is prescribed, the principles of which are set out in the article.

II. Medical therapy .

What medicines to take after gallbladder removal? Immediately, we note that in order to help a sick person with postcholecystectomy syndrome, an individual selection of the drug is necessary. One remedy is assigned first, if the given medicinal product helps very well. If not, then another medicine is selected.

the main goal drug therapy- to achieve a normal passage (movement) of bile through the common hepatic and common bile ducts and pancreatic juice through the main pancreatic duct. This condition almost completely relieves pain in postcholecystectomy syndrome.

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What medications can help achieve this goal?

1. Appointment of antispasmodics

A. Spasm relief and a quick analgesic effect can be obtained with nitroglycerin. Yes, it's nitroglycerin. The medicine that helps with pain in the heart will also help in this case. but long-term use this drug is not recommended: possible side effects, pronounced impact on performance of cardio-vascular system. At long-term use nitroglycerin may become addictive to the drug, then the effect of taking it will be insignificant.

2. Anticholinergic drugs (methacin, buscopan).

These drugs also have antispasmodic action however, their efficacy in sphincter of Oddi dysfunction is low. In addition, they have a lot of unpleasant side effects: dry mouth, urinary retention, increased heart rate (tachycardia), visual impairment may occur.

3. Myotropic antispasmodics: drotaverine (no-shpa), mebeverine, benziklan.

They relieve spasm of the sphincter of Oddi well, however, there is an individual sensitivity to these drugs: they help someone better, and someone worse. In addition, myotropic antispasmodics are also not without side effects due to their effect on vascular tone, urinary system, activity of the gastrointestinal tract.

4. Gepabene - a combined drug with antispasmodic action, stimulates bile secretion and has hepatoprotective properties (protects liver cells).

III. If the above drugs do not help when using all the options for their combination, or the side effects from them are too significant and significantly worsen the quality of life, then surgical intervention– endoscopic papillosphincterotomy . FGDS is performed, during this procedure, a papillot is inserted into the large duodenal papilla - a special string through which current passes, due to which bloodless dissection of tissues occurs. As a result of the procedure, the large duodenal papilla is dissected, thereby normalizing the flow of bile and pancreatic juice into the duodenum, pain stops. Due to this technique, it is also possible to remove the remaining stones in the common bile duct.

IV. In order to improve the digestion of fats, eliminate enzymatic deficiency, they are prescribed enzyme preparations (creon, pancitrate), their combination with bile acids (festal, panzinorm forte) is possible. The course of treatment with these drugs is long, it is necessary to use them for prophylactic purposes.

V. According to indications, in order to reduce the pain syndrome, sometimes prescribed non-steroidal anti-inflammatory drugs (diclofenac).

VI. Cholecystectomy can lead to a disruption of the normal intestinal biocenosis, a decrease in the growth of normal microflora and the development of pathological flora. In such a situation, it is intestinal decontamination . First appointed antibacterial drugs(doxycycline, furazolidone, metronidazole, intetrix) in short courses of 5-7 days. After that, the patient takes drugs containing normal strains of the intestinal flora (probiotics) and agents that improve their growth (prebiotics). Probiotics include, for example, bifidumbacterin, linex, and prebiotics - hilak-forte.

VII. In order to prevent the damaging effects of bile acids on the intestinal mucosa, antacids containing aluminum are prescribed - Maalox, Almagel.

In the presence of erosive and ulcerative lesions gastrointestinal tract shows the appointment antisecretory drugs , the most effective inhibitors proton pump(omez, nexium, pariet).

VIII. Very often, due to indigestion, patients are concerned about bloating (flatulence). In such situations, it helps to assign defoamers(simethicone, combined drugs containing pancreatin and dimethicone).

IX. Dispensary observation at the doctor's .

With the development of postcholecystectomy syndrome, patients should be under medical supervision for 6 months. Spa treatment can be carried out 6 months after the operation.

NOW, we understood that the consequences of gallbladder removal are due to the previous long course cholelithiasis with the formation of functional and organic changes in anatomically and functionally interconnected organs (liver, pancreas, stomach, small intestine).

A certain contribution to the development of postcholecystectomy syndrome is made by technical difficulties and complications during the operation to remove the gallbladder. But we'll fix it. First, a complex drug treatment if it does not help, then minimally invasive surgery is performed.

I invite you to watch the video Gallbladder - What you can and cannot eat after surgery. The recommendations of doctors and nutritionists will help you avoid complications and minimize all Negative consequences after gallbladder surgery.

Removal of the gallbladder. Consequences. Reviews

I had an operation to remove my gallbladder laparoscopic method. In the first days after the operation, weakness was observed, there were slight pains in the right side, where the punctures themselves were. When sneezing, coughing, the pain could intensify. But the situation quickly returned to normal. I followed the diet. And I advise everyone to stick to the first year, a year and a half. And then the menu can be expanded. But always look at your well-being. Some products still cause bloating in my stomach, sometimes there is bitterness in my mouth, nausea. But as soon as I review my diet (I already know products that can cause such a state), the picture returns to normal. It's been 20 years. I live and enjoy life. It is also very important to think positively, to set yourself up that everything will be fine. I am actively involved in sports, go to dances - in a word, a common person, I do not feel any consequences after the operation of the gallbladder.

Feedback from a reader of my blog

After the operation to remove the gallbladder, I felt very bad. My side hurt, I could not eat anything, bilirubin was 75/10/65. I had to search the Internet for answers to questions that tormented me. Having found Dr. Evgeny through the blog of Irina Zaitseva, I began to receive consultations, thanks to which, after 5 months, my bilirubin became 15.7. I started to eat within reason, but I am expanding the assortment. I exclude three "F": fatty, yolks, fried, as advised by Dr. Evgeny Snegir. Even the fact that there is such a doctor who will support, prompt, advise is very convenient, because it takes time to get to the doctor and they will not always accept. But EUGENE did not leave any of my appeals unanswered.
Novikova Lydia. Voronezh. I am 61 years old. Pensioner.

Diet and nutrition after gallbladder removal