Surgery to remove the gallbladder is a major intervention digestive system... After the operation, the patient needs to adhere to certain recommendations in order to prevent deterioration of health. Subject to all the rules, a person may well live for several more decades, lead a normal life, and carry out everyday activities. Deleted gall bladder and you want to know what the consequences might be? Then this article is for you.

The gallbladder is a small pear-shaped organ. In length, it does not exceed 14 cm (the normal length is from 8 cm to 14 cm), in width only 3-5 cm.

Its main task is the accumulation and storage of bile, which is formed in liver cells. It holds up to 70 cubic centimeters of bile. Being here, bile acquires a thicker texture, after which it is evacuated through the bile ducts into the intestines through the sphincter of Oddi, where it takes part in the breakdown of food.

Functions of the gallbladder:

  1. Accumulative, or depositing. All the bile produced by the liver is collected here.
  2. Concentration is reduced to thickening of bile.
  3. Evacuation. When the gallbladder contracts, pushing the contents out, it enters the duodenum through the ducts. In this case, bile is not thrown out constantly or with a certain frequency, but only when it is necessary for the breakdown of food. If this function is impaired, bile stagnates, thickens excessively. Over time, this leads to the formation of sand and stones.

Bile is essential for the breakdown of food. It is also a powerful antiseptic - it disinfects the contents of the intestines, kills most pathogenic and surplus opportunistic bacteria. It is thanks to her that a person does not get an intestinal infection every time he eats an imperfectly fresh or clean product.

In the duodenum, it creates an alkaline environment that is destructive for the larvae of most helminths. If the bile is sufficiently concentrated, the function of the gallbladder is not impaired - a person manages to avoid infection with helminths even if they enter the intestines with food.

It is also responsible for the breakdown and absorption of fats, stimulates intestinal motility, and participates in the formation of intra-articular fluid.

Violation of the outflow of bile, its insufficient amount leads to indigestion. Such patients often have constipation, intestinal dysbiosis, and impaired fat absorption.

If the outflow of bile is disturbed, inflammation of the gallbladder develops, a sediment appears, which eventually collects into stones. To relieve inflammation and prevent the formation of stones, choleretic drugs are prescribed.

Indications for removal of the gallbladder

Cholecystectomy is a radical operation, after which a person's life changes somewhat. Therefore, for no reason, only with preventive purpose this operation is not performed. The indications for surgery are presented in the table below.

Table 1. Indications for surgery to remove the gallbladder

DiagnosisDescription
CholelithiasisThe most common cause of cholecystectomy. This disease is diagnosed in about one in 10 people in the world. But not everyone needs an operation to remove the gallbladder - only those who have biliary colic from time to time and are at risk of blocking the bile ducts. If the stone lies at the bottom of the bladder and does not block the outflow of bile, there is no reason to remove the bladder.
Blockage of the bile ductsA dangerous condition in which the outflow of bile is impaired. The main reasons are divided into two groups: internal and arising as a result of external influences. Often this condition occurs in overweight people, as a result of injury, etc.
CholecystitisInflammation of the gallbladder is one of the most common diseases. A person can live with him all his life - subject to nutritional control and periodic preventive treatment. But in some cases, complications arise that lead to the need to remove the gallbladder.
TumorsIt can be benign (adenoma, fibroma, papilloma) or malignant. Even if the patient is diagnosed with a benign formation, it is better to remove the bile duct, since the risk of its transformation into a malignant one is very high. Directly, gallbladder cancer is diagnosed in every sixth case of oncology.
Kinked gallbladderThe phenomenon is rare, but not amenable to conservative treatment. May be congenital or acquired - as a result of abdominal trauma or severe inflammation in abdominal cavity... Doctors may prescribe medication that will improve bile flow and prevent it from stagnating, but medication will not correct the kink. In the presence of an inflection, the gallbladder does not perform its functions, the motility of the gastrointestinal tract is impaired. If, as a result of deformity, the bile ducts are not blocked, a person can live with this pathology by taking supportive medications. If the ducts are blocked, the outflow of bile does not occur at all - surgery is necessary. But it is worth noting that this pathology is quite rare.

Is it possible to do without surgery?

Gallstone disease and other diseases may not make themselves felt for a long time. Quite frequent are situations when gallstones are found by chance, during a preventive examination. Moreover, the person does not have any symptoms of the disease. In this case, you can not rush to the operation. But it is necessary to be examined from time to time in order to detect a deterioration in time.

If the disease is accompanied by unpleasant symptoms (biliary colic, yellowness of the skin and mucous membranes, digestive disorders, pain in the right hypochondrium, nausea and vomiting), the operation to remove the gallbladder should be performed as early as possible. This will allow the patient to get rid of the painful manifestations of the disease and avoid serious complications.

How is the operation going?

Surgical removal is performed during the period of remission of the disease. In this case, it is easier for the patient to transfer the intervention, the recovery process is faster. But in some cases, when the condition is life threatening, they operate in an acute condition.

There are two main methods:

  1. Laparoscopic surgery is less invasive because it is performed through small punctures.
  2. Open cholecystectomy is a classic operation that is performed through a relatively large incision in the right hypochondrium.

After its completion, the patient remains in the clinic for postoperative observation for only 1-2 days. Full recovery and return to the usual rhythm of life takes no more than 20 days. The seam after the operation is minimal, painful sensations are mild. These are all the indisputable advantages of this method, thanks to which it is easier for patients to agree to surgical treatment. it perfect option in the event that there are no complications and contraindications.

It is undesirable to use laparoscopy if the patient has serious heart and vascular diseases. This is due to the fact that during the operation, carbon dioxide is injected into the site of the intervention to facilitate access. Increased pressure on the diaphragm, as well as the veins of the systemic circulation, can provoke complications from the heart and respiratory system.

Also, it is impossible to carry out laparoscopy in acute cases, in the presence of tumors, with peritonitis and acute pancreatitis, gallbladder calcification.

Open cholecystectomy

The course of this operation has been worked out for decades. Although recovery takes longer, open surgery gives the surgeon more room to maneuver if complications or additional pathologies are found after the incision. It takes about the same time as laparoscopy. But in the presence of a tumor, it allows you to remove it as much as possible.

If inflammation of the peritoneum (peritonitis) is present, additional debridement can be performed during surgery to prevent blood poisoning.

If the operation takes place without complications, the stitches are removed after 7 days, and the patient is discharged home on day 12-14. But at first he needs to limit physical activity... Only after 2.5 months can you start doing light gymnastics, which, by the way, is further necessary for the normal functioning of the digestive system.

Rehabilitation after removal of the gallbladder

Bile is directly involved in the digestion process and regulates intestinal motility. Accordingly, after its removal, these functions must be compensated. For this, a whole range of methods is used: from taking medications to therapeutic exercises, which will help restore intestinal motility and not gain excess weight.

Diet

Proper nutrition is an important part of a patient's life after gallbladder removal. Since the digestive system is now functioning in a new way, you need to be even more careful about what goes into the stomach.

It is necessary to completely exclude heavy fatty foods, fried foods, strong alcohol, foods without heat treatment. Raw vegetables and fruits can only be consumed by those who have constipation - and then in small quantities. Most of the diet should be cooked vegetables, lean meat.

After removing the gallbladder, you can use:

  • light soups in low-fat broth;
  • boiled, stewed or baked vegetables and fruits;
  • lean chicken meat (fillet);
  • soufflé and casseroles (vegetable - without a lot of cheese);
  • lean fish;
  • steam cutlets from lean meat or fish;
  • fermented milk products - ideally fresh and only if the body tolerates it well;
  • cereals - only if they are thoroughly cooked;
  • a small amount of vegetable and butter is allowed.

You can not eat foods that provoke an increase in the production of gastric juice: lemons and lemon juice, sour fruits. Also contraindicated:

  • carbonated drinks;
  • coffee and caffeinated drinks;
  • pastries and pastries with cream;
  • pickled and salted vegetables;
  • white cabbage;
  • radish;
  • sorrel, spinach;
  • canned food (meat and fish);
  • nuts and seeds, especially roasted;
  • legumes.

All food must be chewed thoroughly. Such a person needs to eat at least 5 times a day, observing approximately the same intervals and avoiding periods of prolonged fasting. The portions should be small because without the gallbladder, it is very difficult for the digestive system to digest large portions. Within a few months after the operation, the bile ducts dilate slightly, which provides a larger volume of bile entering the duodenum. But this is still not a complete replacement for the gallbladder.

You should not go to extremes and eat exclusively pureed food: this will slow down the work of the entire digestive system, reduce intestinal motility.

The diet should be especially strict in the first 2 months after surgery. At this time, even lean meat, any raw fruits and vegetables are not allowed: only light food that has undergone a thorough heat treatment.

If after a meal there is pain, nausea, vomiting, fever, you should seek the advice of your doctor. It is also important to remember after what products such a reaction occurred.

An important point: the diet after removal of the gallbladder is not a temporary phenomenon. It is necessary for the patient to adhere to it for the rest of his life in order to prevent other serious diseases of the digestive system.

Taking medications

After removal of the gallbladder, it is important that the outflow of bile from the hepatic ducts is timely. In case of stagnation, inflammation of the liver may develop. And if the operation was preceded by gallstone disease, and the patient's bile itself is thick, new stones can form in the hepatic ducts.

A sudden release of a large amount of bile or its constant flow into the empty intestine leads to the formation of duodenitis (inflammation of the duodenum), ulcer of the duodenum and intestines.

To reduce the likelihood of these complications and normalize the digestive system, after surgery, patients are prescribed choleretic and other drugs.

Medications used after cholecystectomy:


It is important to remember that the more carefully the patient adheres to dietary recommendations, the fewer ancillary drugs he needs to take.

Gymnastics

Special therapeutic exercises will help to normalize the outflow of bile from the hepatic ducts, to stimulate intestinal motility. The main exercises are aimed at strengthening the anterior abdominal wall.

Many patients can do the exercises at home. But if a person has a lot of excess weight, especially abdominal obesity, it is better to study in a special group under the supervision of a medical instructor.

In the first days after the operation, it is necessary to observe bed rest, which means that any physical activity is excluded. After removing the stitches, you can begin to perform breathing exercises... The so-called diaphragmatic breathing (in which the muscles of the diaphragm are involved) will help restore blood circulation and prevent thrombosis, as well as preserve intestinal motility.

A light warm-up of the joints will not hurt either. Firstly, it does not create a burden on the area of ​​the operation. Secondly, with a decrease in bile production, the amount of joint lubrication decreases, which can lead to limited mobility and inflammatory diseases of the joints. Light joint exercises will help maintain mobility and stimulate blood circulation in the joint area.

A few weeks after the operation and after consulting a doctor, you can start exercises to strengthen the abdominal muscles. You need to start with the minimum number of repetitions, increasing the number by 1-2 times a week. If pain occurs during exercise, and then the temperature rises, you need to stop gymnastics and consult a doctor.

Walking stairs will also be effective. It simultaneously has a beneficial effect on joints, intestines, and helps prevent weight gain.

A few months after the operation, weights can be used, optional equipment, to ski. For an even load, a set of exercises (it takes 10-15 minutes) must be performed twice a day:

  • in the morning on an empty stomach, before breakfast, to stimulate the production of bile;
  • in the evening, an hour before bedtime, to normalize bowel function and improve the outflow of bile accumulated during the day from the hepatic ducts.

Don't limit yourself to just abdominal exercises. You need to start with breathing and light warm-ups, then perform several exercises for the joints (first for the arms, then for the legs), and then do exercises to strengthen the abdominal wall.

Medical statistics say: those patients who do not ignore gymnastics recover faster and are much less likely to face subsequent possible complications of cholecystectomy.

Possible complications after removal of the gallbladder

Adaptation and restoration in each case occurs individually. The more chronic diseases a person has, the more difficult and longer it will be to recover. Such patients require regular check-ups, ancillary medications and strict adherence to a diet.

Complications after surgery occur in about 5-10% of cases.

Postcholecystectomy syndrome

This diagnosis appeared in the 30s of the last century. It is associated with hypertonicity and spasm of the sphincter of Oddi, which ensures the flow of bile into the duodenum. The sphincter does not hold back bile, which is why it constantly enters the intestines unhindered, causing irritation. Among the main symptoms of PCES:

  • Stool disorder (cold diarrhea)
  • spasm and pain in the right hypochondrium;
  • nausea;
  • belching;
  • bloating of the intestines.

When the intestines are irritated, Oddi's sphincter contracts, blocking the bile duct. As a result, bile accumulates in the hepatic ducts, stagnates, provokes the development of the inflammatory process.

To treat this syndrome, conservative drug therapy and a strict diet are used.

Duodenitis

Inflammation of the duodenum develops with constant irritation with bile, as well as with indigestion as a result of a lack of bile and digestive enzymes. If untreated, it can eventually transform into an ulcer. Sometimes enteritis occurs - inflammation of the small intestine, provoked by the effects of bile and SIBO.

Duodenitis often occurs in patients with Helicobacter-associated gastritis. To avoid this complication, it is advisable to treat Helicobacter pylori infection before removing the gallbladder.

Bacterial overgrowth syndrome

In the presence of chronic inflammation of the gastrointestinal tract and intestinal dysbiosis, the patient needs to take such drugs constantly.

Pancreatitis

Almost 80% of patients with gallstone disease are diagnosed. It remains after cholecystectomy. Sometimes this disease occurs after surgery due to a decrease in concentration and bile and a stimulating effect on the pancreas.

When the ducts are blocked with stones (small stones can enter the area of ​​the sphincter of Oddi and the pancreatic ducts with the flow of bile), with a spasm of the sphincter of Oddi, congestion occurs in the pancreas, which leads to its inflammation. Approximately 40% of those who underwent cholecystectomy experience a decrease in the production of pancreatic juice. You can solve this problem with a strict diet and enzyme preparations.

Diabetes

It occurs against the background of serious disturbances in the work of the pancreas, a decrease in the production of enzymes and insulin. An additional risk factor is the presence excess weight the patient. Therefore, after removing the gallbladder, it is important to control the blood sugar level in order to take action at the slightest change and prevent the development of the disease.

Arthritis and arthrosis

With a decrease in the concentration of bile, the production of intra-articular lubricant decreases. Mechanical erasure of the cartilage occurs. If there is a source of chronic infection in the body, this process is faster. Therefore, after the operation to remove the gallbladder, it is important to do gymnastics for the joints, drink more fluids, and eat foods rich in collagen. If there is pain, crunching in the joint, restriction of mobility or swelling, you should consult your doctor.

Cholecystectomy and pregnancy

Gallbladder disease is three times more likely to occur in women than in men. There are also more women among the operated patients. In the presence of cholecystitis and even with a hereditary predisposition in women during pregnancy, the likelihood of the formation of stones in the gallbladder and blockage of the bile ducts increases due to high blood pressure growing uterus on all organs of the abdominal cavity.

Operations to remove the gallbladder in the presence of serious indications are performed during pregnancy. Laparoscopy is contraindicated - only open surgery is performed. In addition, the anesthesia itself, the operation and the recovery period are a shock for the woman's body and can negatively affect the course of pregnancy. Therefore, if there are indications, it is better to carry out the operation before pregnancy.

The absence of a gallbladder is not an obstacle to the onset of pregnancy and successful gestation. But pregnant women after cholecystectomy are much more likely to experience early toxicosis. Also, digestive disorders during pregnancy occur in almost 100% of women with a removed gallbladder.

If a woman underwent cholecystectomy, pregnancy can be planned no earlier than 3 months after the operation - after complete recovery. Throughout pregnancy, it is important to eat well and stay physically active.

Removal of the gallbladder is not a sentence. Subject to medical recommendations, the patient can live to a ripe old age without serious complications.

Video - Features of the recovery period after removal of the gallbladder

A person in life has a lot of joys and one of them, so to speak, is the most accessible and pleasant - the ability to suppress hunger delicious food... Some call it gluttony, while others call it gourmet. Be that as it may, it is important not to forget about the sense of proportion: eat fractionally and at certain hours, give preference to healthy and low-calorie food. Since skipping breakfast / lunch, overeating (especially at night) over time can lead to sad consequences - the deposition of stones in the gallbladder and, accordingly, to the removal of the hollow organ. For your information, in addition to gallstone disease, there are others.

The first harbinger of such a threat is bitterness in the mouth after sleep. However, even in this case, you can do without. But if cholecystectomy is inevitable, then it is very important to learn how to live properly without this organ. Let's consider what drugs and in what cases are recommended for patients in the rehabilitation period.

Postoperative rehabilitation

After the operation, it will take about a year to “teach” the bile ducts to “do the work” of the removed organ. The bottom line is that cholecystectomy has little effect on the patient's quality of life from the point of view of physiology: since stones are formed in an organ that is already poorly functioning or does not work at all. For this reason, the human body, after cutting out the bubble, feels a kind of relief, because it almost painlessly "says goodbye" to one of its many problems. However, the postoperative period is different for each person.

Rehabilitation after cholecystectomy is carried out in the following areas:

  1. drug therapy;
  2. strict adherence to diet;
  3. adherence to the diet;
  4. physiotherapy.

At first, the stomach, pancreas, liver and intestines begin to adapt to the new mode of work. At this time, the patient needs supportive drug therapy. Taking special medications facilitates and accelerates the course of digestion. Postoperative drug therapy is prescribed by a doctor in individually, this takes into account the peculiarity of the operation, the general health of the patient, his age and other factors.

Most often, doctors prescribe the following medications:

  • antispasmodics - substances that reduce smooth muscle spasm;
  • enzyme preparations - medicines that improve the digestion process and include digestive enzymes in their composition;
  • drugs that improve the intestinal microflora;
  • hepatoprotectors - a group of drugs used to treat and restore the liver.

Drug therapy after cholecystectomy

Patients who have undergone surgery, who are in good health, mood and do not complain of pain in the liver and other discomfort, usually do not need special treatment. All that is required of them is to know and adhere to a special, not very strict diet.

Medicines for "bacterial overgrowth syndrome"

Aching pain occurs in about 40% of patients after cholecystectomy. In addition, there are others, for example:

  • belching;
  • flatulence;
  • bitterness in the mouth;
  • stool problems;
  • nausea.

These sensations are often due to the fact that bile ceases to perform its bactericidal function, microbes multiply in the duodenum, as a result of which their number begins to exceed the norm. Scientists call this condition the small intestine bacterial overgrowth syndrome. It is treated with antimicrobial agents (furazolidone and biseptol). Courses of antibiotics and medications designed to restore the intestinal microflora significantly improve the well-being of these patients. In this case, antibiotics are prescribed strictly according to indications. As a rule, they are recommended to be taken within 5-7 days, then a course of medications is required to restore the normal microflora in the intestine:

  • linex;
  • bifidum;
  • bifidobacterin, etc.

During antibiotic treatment, you must drink a multivitamin.

Treating other problems of the digestive system

Sometimes people who have undergone surgery may be concerned about pain of a different nature, caused by other problems of the digestive system. Discomfort can be caused by concomitant pancreatitis, liver damage, stomach disease, or biliary dysfunction.

Previously, these diseases were combined into a single group "postcholecystectomy syndrome". Today, operated patients are prescribed individual treatment, which depends on the nature of the problem. So, in case of violations caused by the cause of dysfunction of the biliary tract, it is necessary to take antispasmodics:

  • no-shpu;
  • duspatalin;
  • buscopan, etc.

The antispasmodic of the new generation mebeverin has proven itself well, which promotes the easy flow of bile into the duodenum. This remedy is dispensed with a doctor's prescription. Medicines that eliminate spasm can be drunk in a course of 2-4 weeks, they can also be recommended for admission only when pain occurs.

With concomitant pancreatitis (inflammation of the pancreas, provoked by its defeat by its own enzymes), enzyme agents and medications are needed that reduce gastric secretion. Enzyme medicines include:

  • creon;
  • pancreatin;
  • micrasim, etc.

Enzymes also have pain relieving effects. The duration of the course and the dosage are selected individually.

If the pain is caused by increased gas production in the intestine, then to eliminate these symptoms you need to drink:

  • meteospasm;
  • espumisan;
  • sub-simplex, etc.

Plus, foods that contribute to the accumulation of gases should be excluded from the diet:

  • bananas;
  • cabbage;
  • legumes;
  • drinks with gas;
  • grapes and raisins;
  • fresh bread;
  • fried and fatty foods;
  • whole milk.

To ensure the normal functioning of the duodenum and the sphincter of Oddi, you need to drink prokinetics (drugs that stimulate the motility of the gastrointestinal tract) 15 minutes before a meal:

  • motilium;
  • debridate;
  • cerucal.

As well as polyenzyme and fortifying medicines: Essentiale Forte, Creon, Festal, vitamins.

Advice: independent choice medicines can not only not improve, but also aggravate the condition. The side effects of the prescribed medications must be reported to the attending physician. Only he can replace one remedy with another, taking into account the general picture of the rehabilitation period.

How to avoid relapse?

Duodenal examination of the duodenum

First of all, you need to understand that bladder problems arise due to an unhealthy liver. If the liver is not healthy, it reduces the quality of bile. The operation does not affect the composition of the bile. This means that the production of stone-forming bile by hepatocytes (liver cells) can persist. This phenomenon is called "biliary insufficiency". Therefore, the main task in the postoperative period is the biochemical analysis of the composition of bile, carried out at regular intervals. Ultrasound examination cannot show an appropriate result. Therefore, doctors choose duodenal examination of the duodenum. In order to find out if there is a risk of recurrence or secondary formation of stones, 5 ml of liquid is placed in the refrigerator for 12 hours. If a sediment forms during this time, then the bile produced by the liver is capable of forming new stones.

In this case, the doctor prescribes medicines containing bile and bile acids:

  • cholenzyme;
  • lyobil;
  • allochol.

These drugs are used for replacement therapy for biliary insufficiency due to the absence of the gallbladder. There are other tablets that stimulate the formation and secretion of bile: osalmide and cyclovalon.

Advice: all appointments to patients in the postoperative period are made strictly on an individual basis! Do not take choleretic drugs on the advice of friends, acquaintances and pharmacy workers!

To protect the mucous membranes from the toxic effects of bile acids, it is necessary to drink 300-500 mg ursodeoxycholic acid before bedtime. This acid is found in the following medicines:

  • enterosan;
  • hepatosan;
  • ursofalk;
  • ursosan.

The last two medicines have exactly the same effect, the only difference is that the first is more common in the East, and the second in Europe.

Hepatoprotectors

Hepatoprotectors are not pain relievers, but they protect liver cells, have a beneficial effect on the composition of bile and have an anti-inflammatory effect. These funds are usually included in complex treatment and are prescribed in courses lasting 1-6 months. These include:

  • hepabene;
  • ursosan;
  • eslidin;
  • essential forte;
  • milk thistle extract.

Timely and correct assessment of the patient's clinical symptoms after removal of the gallbladder makes it possible to choose the optimal therapy and, as a result, improve the quality of life of the operated patient.

Attention! The information on the site is provided by specialists, but it is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!

The gallbladder is removed after the formation of many solid particles that clog the bile duct - common bile duct. Surgery does not always cure concomitant diseases. The operation saves the life of a person in difficult and emergency cases... After removal of the bladder, the symptoms of the disease disappear, and the pathological condition and malfunctioning of organs remain. We have to resort to medication. Only a doctor can tell you which medications to take after gallbladder removal. Self-medication will only complicate the situation.

Consequences of removing the gallbladder

After removal of the gallbladder, it is necessary to maintain the functioning of the gastrointestinal tract. If earlier bile entered the duodenum after food entered the stomach at the right time in sufficient volume, now, in the absence of its storage, it will slowly go in small portions directly from the hepatic ducts.

Lack of bile affects the small intestine. It plays a bactericidal role, so it is necessary to take care of the health of the digestive tract.

Stagnation of bile in the liver ducts can lead to inflammation. If the work of the outlet sphincter of the biliary tract is disrupted, then the secret either stagnates, causing irritation of the mucous membranes of the ducts, or spontaneously enters the duodenum. Duodenitis is possible, throwing bile into the stomach with the appearance of heartburn. Frequent heartburn is the first sign of developing gastritis. It is necessary to take medications that protect the mucous membranes of the stomach and intestines.

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Lack of bile has a negative effect on the breakdown of fats from food. Irregular bowel movements and constipation occur. Fat-soluble substances, calcium, cholesterol are poorly absorbed.

Enzymes

Enzyme preparations help break down food. After the operation, Mezim or Festal is prescribed, as an addition to the insufficient amount of bile. They contain enzymes that decompose proteins, carbohydrates, fats. They have a mild analgesic effect. These drugs contain pancreatic enzymes. In a healthy body, bile, entering the duodenum, stimulates the secretion of pancreatic juice. Since bile is poorly secreted after surgery, or there is not enough bile, medications with a complex of enzymes are prescribed.

Creon is also an enzyme preparation. The unique structure of the drug allows you to distribute the contents of Creon microcapsules throughout the small intestine. This ensures enhanced breakdown of BJU, complete absorption of nutrients from food, and normal bowel function.

Antispasmodics

No-shpa is a strong antispasmodic agent that relaxes smooth muscles. Often, pain in the right hypochondrium after removal of the bladder occurs as a result of spasm of the bile ducts during the release of liquid secretion into the intestines. No-spa also relaxes the sphincter of the biliary tract, helping the release of fluid into the intestines. The medicine is rapidly absorbed into the bloodstream. The tablet of the drug begins to act 10 minutes after ingestion. Intramuscular injection work faster and more complete.

Mebeverin or Duspatalin are myotropic drugs. Relaxes the smooth muscles of the gastrointestinal tract. Completely disintegrate in the body. Well relieve spasms, colic, remove abdominal discomfort, bowel upset. They begin to act 20 minutes after taking the pill. Reviews of the drugs are very positive. Adverse reactions are extremely rare.

Choleretic drugs

Often patients after cholecystectomy are interested in whether choleretic drugs can be taken. Yes, since these drugs will protect the liver from stagnation of hepatic secretions, prevent inflammatory diseases of the organ, and ensure normal digestion and bowel function. After removing the bladder, it is not recommended to eat fatty, spicy foods. These drugs help to cope with the digestion and absorption of food.

Allohol

Allohol - tablets of natural origin. It enhances the formation of bile in the liver, has a positive effect on the work of this organ. Reduces the likelihood of recurrence of the formation of gallstones by thinning the secretions of the liver. The medicine reduces the formation of putrefactive processes in the intestines. Eliminates flatulence and constipation. It consists of 70% pork bile. Additionally, it contains garlic and nettle extract. 10% of the drug accounts for Activated carbon which neutralizes bowel discomfort.

Cholenzyme

Cholenzym is a complex preparation consisting of animal components: dry bile, dried pancreas and mucous membranes of the intestines of cows. It stimulates the production of bile, enhances its permeability along the biliary tract. The enzymes in Cholenzym quickly break down food, fight against the appearance of heaviness in the abdomen, bloating, constipation, and discomfort.

Holosas is a herbal preparation. It contains rosehip extract, rich in flavonoids, pectins, acids, vitamins, essential oils... It is a sugary-sweet liquid with a dark color. It works well for the liver. It enhances the production of bile, improves its passage through the liver ducts and excretory tracts, and dilutes this liquid substance. Has a relaxing effect on the smooth muscles of the gastrointestinal tract. Strengthens the secretion of the pancreas, bowel function. The complex of vitamins and acids performs antimicrobial, anti-inflammatory, tonic and anti-aging functions. Rosehip extract is completely decomposed in the liver, providing a bactericidal effect.

Hepatoprotectors

What are hepatoprotectors? This group includes drugs that have a restorative effect on liver cells, increase the production of bile, improve its composition, liquefy, treat the liver after removing the gallbladder. Biliary cirrhosis of the liver resulting from impaired drainage of bile from the liver is positively treatable with hepatoprotectors. If the amount of bilirubin deviates from the norm, these drugs are also prescribed.

Carsil

Carsil is a herbal medicine. It contains milk thistle extract. The active substance Karsil revitalizes liver cells, blocks the action of toxins and viruses. Strengthens the secretion of bile, has a relaxing effect on the sphincters of the excretory tract. Patients with chronic liver diseases, taking Carsil, notice an improvement in their general condition, a decrease in pain, and a normalization of digestion. Normalizes the readings of hepatic secretions. After removal of the gallbladder, Karsil is prescribed as maintenance therapy to stabilize the gastrointestinal tract, in the process of getting used to the body to live without a bile depot, fulfilling its role, preventing possible inflammation of the liver.

It is often argued which is better to take - Carsil or Essentiale Forte? If Carsil is a herbal medicine, Essentiale is created by chemical synthesis. Its action is much broader. The main function is to fight the fat cells of the liver. The active substance Essentiale has a high penetrating ability into the cell, acts on mitochondria. It enhances intracellular metabolism. Indications for the use of Essentiale are: various inflammatory liver diseases, radiation. In patients after surgery to remove the gallbladder, it is used as a treatment for chronic liver disease with impaired bile production.

Urdoksa is a hepatoprotector that enhances the formation and excretion of bile. It also lowers cholesterol levels. It has a strengthening, tonic effect on the body. Urdoksa treats biliary cirrhosis, gastritis caused by the throwing of bile into the stomach, dissolves small formations of hepatic secretion. This function helps to avoid the reappearance of gallstone disease after removal of the bladder. The drug is included in the maintenance therapy of the first half of the year after cholecystectomy, in the process of establishing the patient's diet.

Ursofalk

Ursofalk is an extended-action drug. Indications for use are similar to Urdoksa, only Ursofalk is capable of deep penetration into liver cells, restoring intracellular metabolism. Restores cells damaged by toxic substances and alcohol. It has a good relaxing rehabilitative effect on the common bile duct with sclerosis of the walls, spasms, destruction under the influence of stagnant hepatic fluid.

After removing the gallbladder, it is important to undergo a course of rehabilitation treatment to adapt the body to the changed conditions of existence. Maintaining the health of the liver and monitoring its performance, the functioning of the intestines will take a lifetime. To avoid the possible negative consequences of the absence of a gallbladder, it is important to follow a diet, doctor's prescriptions, and lead a healthy lifestyle.

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Among diseases of the gastrointestinal tract, the third place is occupied by pathologies of the biliary system. In most cases, the problem is solved by removing the gallbladder, and the consequences and feedback from patients after surgery are usually positive. A person gets rid of everyday pain and discomfort.

What pathologies are operated on

Gallstone disease is a multivalent pathology, during which stones are formed in the gallbladder. The mechanism of formation is as follows: as a result of congenital or acquired disorders of the metabolism of cholesterol and bile acids, calculi are formed. A concomitant factor is a violation of the well-coordinated work of the ducts that excrete bile, and the attachment of infectious agents. The clinical manifestations of the disease, removal of the gallbladder, the consequences and prognosis in each individual variant will depend on the stage of stone formation, the primary site of localization, as well as on the individual specificity of the patient's body.

The second most common pathology that needs to be operated on is acute cholecystitis. Simply put, inflammation of the gallbladder. It is mostly caused by infectious agents. In 80% of cases, patients come to the hospital when complications develop, and this entails immediate removal of the gallbladder. The consequences, reviews after the operation indicate good prognosis. To carry out surgery, you need to understand what morphological component we are dealing with.

Treatment

Cholecystectomy is the only one possible way remove the gallbladder. But if there are no indications for surgery, you can try conservative treatment. It is based on taking antibiotics, analgesics, antispasmodic drugs.

Indications for surgery

They are conventionally divided into absolute and relative. Absolute indications for cholecystectomy:

  • acute cholecystitis;
  • chronic course of cholecystitis, the anamnesis is not burdened, and the gallbladder is with complete dysfunction;
  • calculi of common bile duct:
  • complete or partial melting of the gallbladder is an urgent cholecystectomy (the safety indicator is higher), but plastic closure of the wound canal is quite rare.

Relative indications for surgery have cholecystitis in a chronic form, if the symptom complex indicates the presence of calculi in the gallbladder. At the same time, it is necessary to carry out a thorough differential diagnosis in order to exclude other diseases of the gastrointestinal tract. An example of such diseases is gastric ulcer and duodenal ulcer.

Contraindications to cholecystectomy

But there are contraindications to this surgical intervention. And if you do not take them into account, then the removal of the gallbladder can have fatal consequences for the patient. They are also conventionally divided into general and relative. If patients have acute coronary (heart) failure, diffuse peritonitis, a significantly reduced blood clotting rate, and also at the 3rd trimester of pregnancy, the operation is postponed. Relative ones are allocated by each surgeon separately, but often these are acute inflammatory processes of the pancreatic gland, gallbladder, the duration of which is more than 3 days, tumor-like formations of the bladder of unexplained etiology.

Operation progress

After the opening of the abdominal cavity, the gallbladder and common bile duct are examined. If an inflammatory accumulation of fluid is detected in the thickness of the hepato-duodenal ligament, the pathology is removed from its distal end to the proximal. A clamp is applied to the bottom of the bubble. A nicotinamide solution is injected under the outer membrane in the bladder bed. It is dissected, after which the desired cystic duct is isolated. Having retreated 0.5 cm from this place, the cystic duct is cut and tied with two ligatures (special threads of natural origin). The abdominal cavity is drained so that the inflammatory accumulations come out to the outside, and do not provoke wound suppuration. After carrying out this type of gallbladder removal, the consequences, the reviews are impeccable. This is because in the course of her bladder all at once is removed, while the likelihood that its contents will enter the abdominal cavity is minimal.

Cholecystectomy technique from the cervix to the bottom

Such removal of the gallbladder (and the consequences, and reviews about it) in the practice of a doctor cannot be compared with that described above. Since with this option, there is a high probability of developing postoperative peritonitis. So, after revision of the gallbladder, it is grasped with a clamp closer to the neck and cut off.

In order to protect yourself, your health and not visit medical institutions, everyone needs to reconsider their lifestyle and diet. Per festive table do not overeat, try to eat in moderation, balanced, and then your body will thank you.

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Gallbladder 08/06/2013

Dear readers, today we are continuing our conversation in the section. There are a lot of articles on this topic on the blog. 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 doctor Evgeny Snegir to help me and comment on the blog, answer your questions and further talk about topics that bother you. Today we will talk about the consequences of removing the gallbladder. I give the floor to Evgeny Snegir, a doctor with extensive experience.

Most often, an operation to remove the gallbladder leads to a complete recovery of the patient. Compliance with diet therapy during the first year after the operation allows you to reliably adapt the digestive system to the changed conditions of functioning, and the person subsequently begins to live a full life. healthy life... However, there are exceptions to any rule. In the postoperative period, for a number of reasons, unpleasant symptoms may appear, the consequences of removing the gallbladder.

Consequences of removing the gallbladder. Postcholecystectomy syndrome

All the consequences of removing the gallbladder are combined into 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 an 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 was 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 pains, upset stools, bloating, general weakness, may be disturbed by nausea or vomiting, and sometimes jaundice even reappears. Patients often complain of bitterness in the mouth after removing the gallbladder. A sick person turns to a doctor with a natural question: “How can this be? I came to the 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 did not go away, I have the same story again. Why is everything so? "

All these questions are clear and legitimate. The doctor by his actions should help, not harm. However, not everything is in his power. A statistical analysis of the problems arising after surgery shows that the symptoms directly related to the absence in the body of the main function of the gallbladder (bile reservation) concern only a small number of patients.

Basically, people complain about the problems arising in connection with diseases of the hepatoduodenopancreatic zone, i.e. diseases of the liver, pancreas and duodenum. Therefore, the term "postcholecystectomy syndrome" currently used by many clinicians is harshly criticized as not reflecting the cause 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 of hepatic colic due to a defective operation, the so-called true postcholecystectomy syndrome. At the same time, complications due to mistakes made during cholecystectomy and associated with damage to the biliary tract are distinguished into a separate group: remaining stones of the common bile and cystic duct, post-traumatic cicatricial stricture of the common bile duct, the remaining part of the gallbladder, pathologically altered stump of the cystic duct, cystic stone duct, cystic duct long, scar area neurinoma and foreign body granuloma;
  • complaints of patients associated with diseases that were not recognized before the operation, arising from inadequate examination of the patient, re-formation of stones.

Postcholecystectomy syndrome. The reasons

Lesion of the extrahepatic biliary tract

According to some researchers, removal of the gallbladder leads to an increase in the volume of the common bile duct. They found that when the gallbladder is not removed, 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. The appearance of disturbing symptoms can lead to strictures of the common bile duct, which can develop as a result of trauma to the common bile duct during surgery or the necessary drainage in the postoperative period. The clinical manifestations of these problems are jaundice and recurrent inflammation of the biliary tract (cholangitis). If the lumen of the common bile duct (common bile duct) is not completely obturated, then the symptoms of bile stagnation (cholestasis) will come to the fore.

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

It is believed that the most common false (residual) stone formation, but again stones in the bile ducts can form only with the phenomena of pronounced stagnation of bile in them, associated with the formation of cicatricial changes in the terminal (end) part of the common bile duct. If the patency of the bile ducts is not impaired, 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 pain development. Its increase, as a rule, is a consequence 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. At the bottom of the stump, neuromas and stones can form, and it can become infected.

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

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

Sphincter of Oddi dysfunction

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

Disruption of the sphincter of Oddi leads to changes in the large duodenal papilla, thereby disrupting the activity of the pancreas, cholangitis or obstructive jaundice occur.

Most studies confirm the fact that after 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 stagnation) 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 the stagnation of bile 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 who underwent surgery.

Bile passage disorders

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

Uncontrolled flow of bile into the intestine when its physical and chemical properties change, disrupts the absorption and digestion of lipids, reduces the ability of the contents of the duodenum to lysis of bacteria, inhibits the growth and development of normal intestinal microflora. The bacterial contamination of the duodenum increases, which leads to a violation of the metabolism of bile acids, leading to damage by the products of their decay of the mucous membrane of the small and large intestines - this is precisely the mechanism of 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, removal of the gallbladder leads to the normalization of its function. So, by 6 months after the operation, the normal secretion of trypsin (an enzyme of the pancreas) is restored, and after 2 years the blood amylase levels are normalized.

However, a long and severe course of cholelithiasis can lead to irreversible changes in the pancreas, which can no longer be corrected by just one removal of the affected gallbladder.

Postcholecystectomy syndrome. Symptoms The clinical picture.

The clinical picture is precisely determined by the causative factors that caused the 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 the passage of bile through the bile ducts is disturbed.

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 stool, constipation, diarrhea.

How is postcholecystectomy syndrome diagnosed?

When the above described complaints appear after the operation, the doctor may prescribe the following types of research.

1. Laboratory research

Biochemical blood test: determination of the level of bilirubin, alkaline phosphatase, gamma glutamyltransferase, AST, ALT, lipase and amylase. It is most informative to perform a biochemical blood test during a painful attack or no later than 6 hours after its end. So, with dysfunction of the sphincter of Oddi, there will be a twofold increase in the level of hepatic or pancreatic enzymes in the specified period of time.

2. Instrumental research

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

Postcholecystectomy syndrome. Treatment.

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

II. Drug therapy .

What medications 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. First, one remedy is prescribed, if the given medicinal product helps, that's very good. If not, then another medicine is selected.

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

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What medications do you take to achieve this goal?

1. Appointment of antispasmodics

A. Removal of spasm and a quick analgesic effect can be obtained with the help of nitroglycerin. Yes, exactly nitroglycerin. The medicine that helps with pain in the heart will help well in this case. However, long-term use of this drug is not recommended: it is possible side effects, pronounced impact on activities of cardio-vascular system... With prolonged use of nitroglycerin, addiction to the drug is possible, then the effect of taking it will be insignificant.

2. Anticholinergic drugs (metacin, buscopan).

These drugs also have an antispasmodic effect, but their effectiveness in dysfunction of the sphincter of Oddi is low. In addition, they have a host of unpleasant side effects: dry mouth, urinary retention, increased heart rate (tachycardia), and visual impairment may occur.

3. Myotropic antispasmodics: drotaverine (no-shpa), mebeverin, bencyclan.

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 devoid of side effects due to their effect on vascular tone, urinary system, and gastrointestinal tract activity.

4. Hepabene is a combined preparation with antispasmodic effect, 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 in this case it is performed surgical intervention - endoscopic papillosphincterotomy ... FGDS is performed, during this procedure, a papillotome is inserted into the large duodenal papilla - a special string through which current flows, due to which bloodless tissue dissection 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, the 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, are prescribed enzyme preparations (creon, pancitrate), possibly their combination with bile acids (festal, panzinorm forte). The course of treatment with these drugs is long; their use is also necessary for prophylactic purposes.

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

Vi. Cholecystectomy can lead to disruption of the normal intestinal biocenosis, a decrease in the growth of normal microflora and the development of pathological flora. In such a situation, intestinal decontamination ... Initially, antibacterial drugs (doxycycline, furazolidone, metronidazole, intetrix) are prescribed in short courses of 5-7 days. After that, the patient takes drugs containing normal strains of 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 effect of bile acids on the intestinal mucosa, antacids containing aluminum are prescribed - maalox, almagel.

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

VIII. Very often, due to indigestion, patients are worried about bloating (flatulence). In such situations, the appointment defoamers(simethicone, combined preparations containing pancreatin and dimethicone).

IX. Dispensary observation by a doctor .

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.

SO, we realized that the consequences of removing the gallbladder are due to the previous long course of gallstone disease with the formation of functional and organic changes in the 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 an operation to remove the gallbladder. But everything is fixable. First, a complex drug treatment is prescribed, if it does not help, then a minimally invasive surgical intervention is performed.

Removal of the gallbladder. Effects. Testimonials

The operation to remove the gallbladder was performed by the laparoscopic method. In the first days after the operation, weakness was observed, there were minor pains in the right side, where the punctures themselves were. When sneezing, coughing, the pain could worsen. But the condition quickly returned to normal. I stuck to a diet. And I advise everyone to stick to one and a half years in the first year. And then the menu can be expanded. But always look at your well-being. Some foods still cause me bloating, sometimes bitterness in my mouth, nausea. But as soon as I revise my diet (I already know the foods that can cause this condition), the picture normalizes. It's been 20 years now. I live and enjoy life. It is also very important to think positively, to set yourself up that everything will be fine. I actively go in for 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 couldn't eat anything, the bilirubin was 75/10/65. I had to search the Internet for answers to questions that tormented me. Having found Doctor Eugene through Irina Zaitseva's blog, I began to receive consultations, thanks to which, after 5 months, I had 15.7 bilirubin. I started eating within reason, but expanding the range. 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 see the doctor and will not always be accepted. But EUGENE did not leave any of my appeals unanswered.
Novikova Lydia. Voronezh. I am 61 years old. Pensioner.