The body has a strong compensatory adaptation capacity and the probability of gastrointestinal reactions (irritable bowel syndrome and steatorrhea, etc.) after laparoscopic cholecystectomy (LC) is not high and lasts relatively little time.
Postoperative gastrointestinal reactions after LC are related to direct bile excretion into the intestine.
The underlying disease of the gallbladder determines the probability of postoperative gastrointestinal reactions in LC, i.e., postoperative gastrointestinal reactions essentially do not occur in patients with significant atrophic cholecystitis.
Minimally invasive biliary stone/polyp removal surgery is an option for young, benign gallbladder disease with good gallbladder function. For older patients, minimally invasive biliary stone/polyp removal surgery is not advocated.
After removal of the gallbladder, the body loses the functions of storage, concentration and bile secretion of the gallbladder, and the bile flow is continuously discharged into the small intestine, losing the regulation of bile secretion by the contraction of the gallbladder by nerve and body fluid factors. The most important result is irritable bowel syndrome and/or fat digestion insufficiency, the former originates from the stimulation of the intestine by bile and accelerated intestinal peristalsis; the latter originates from the relatively insufficient amount of bile for fat digestion when fatty food is consumed, resulting in fat digestion and malabsorption, causing steatorrhea; after a period of time the body will gradually adapt and compensate, and this process usually takes 1-3 months. Therefore, in the early post-cholecystectomy period, it is recommended to eat less and more meals and limit the fat intake appropriately. The diet in the early postoperative period starts from low-fat semi-liquid food or low-fat soft rice, and can be quickly overtaken to normal diet if there is no discomfort.
I. Causes of gastrointestinal reactions after cholecystectomy
After laparoscopic cholecystectomy (LC), many patients with cholecystitis and cholelithiasis often have an increase in the number of stools, loose stools or even diarrhea within 1-3 months, especially when they eat fatty foods. This condition is called “steatorrhea” in medical terms.
Why do patients with cholecystitis and cholelithiasis have steatorrhea after LC? This is because bile is secreted by the liver, which secretes about 800-1000 ml of bile every day. Bile flows into the duodenum through the bile ducts to help digestion of fat and absorption of fat-soluble vitamins A, D, E and K. At the same time, the gallbladder has the function of storage and storage of fatty foods. At the same time, the gallbladder also has the function of storing and concentrating bile.
However, when patients with cholecystitis and cholelithiasis undergo LC, bile secreted by the liver flows directly into the common bile duct and enters the small intestine. When people eat, some of the poorly emulsified fatty food is excreted with feces because the intestine lacks sufficient amount of highly concentrated bile to match and help the digestion and absorption of fat, and then the patient develops diarrhea.
In addition, after gallbladder removal, a large amount of bile produced by the liver enters the intestine directly without being stored and concentrated by the gallbladder, especially when the bile directly stimulates the intestine without food, some sensitive people will have irritable bowel syndrome, causing diarrhea or unformed stools.
After gallbladder removal, the body gradually undergoes compensatory changes to adapt to the needs of digestion and can obtain its own regulatory compensation, that is, through compensatory expansion of the bile ducts, effectively maintaining the normal physiological functions of the body. During the compensatory adaptation phase, the function of digestion and absorption of fat will be temporarily affected to a certain extent. In order to adapt to this change more quickly, people who have had their gallbladders removed should have a low-fat diet and eat less and more meals as appropriate. 1-3 months later, then according to the body’s response to fatty foods, gradually increase fatty foods until the usual normal amount is maintained. If there is discomfort or occurrence of steatorrhea, then reduce some or temporarily do not eat fatty food for several days as appropriate.
Second, the life care after cholecystectomy
The gallbladder is the place where bile is stored in the human body, constantly storing the bile secreted by the liver and concentrating it. When eating, the gallbladder, through its own contraction, discharges the concentrated bile into the duodenum to help digest fat. If the gallbladder has to be removed for various reasons, such as cholecystitis, stones, polyps, gallbladder cancer, etc., people will face a change in their physiological state due to unregulated bile. In this case, the bile will continue to enter the duodenum and not enough bile will be available to aid digestion when people eat, leading to symptoms of indigestion, such as abdominal discomfort, bloating and diarrhea.
Surgical removal of the gallbladder is an effective treatment for gallbladder stones. After surgical removal of gallbladder, patients can obtain their own regulatory compensation after a period of adjustment and recovery, that is, through compensatory dilation of bile ducts to effectively maintain the normal physiological function of the organism. Since the regulation of compensatory function after gallbladder removal takes some time, the digestive function of human body should be relatively weakened at this time after all, therefore, patients after gallbladder removal surgery should pay attention to the following issues in home care.
(1) Dietary guidance to choose easily digestible food. In the near future after surgery, try to reduce the intake of fat and cholesterol, do not eat or eat less fatty meat, fried food, animal offal, etc. If it is necessary for taste, you can use some olive oil to cook food appropriately. To increase the protein-rich food to meet the body’s metabolic needs, such as lean meat, aquatic products, soy products, etc. Eat more foods rich in dietary fiber and vitamins, such as fresh fruits and vegetables. Develop the habit of eating regularly and in small quantities to adapt to the physiological changes after cholecystectomy. The symptoms of indigestion will last about six months, and as time goes by, the common bile duct will gradually dilate and will partially replace the gallbladder function, and the symptoms of indigestion will slowly ease. At this time, the diet will gradually return to normal.
(2) Resume normal diet, it is advisable to maintain a low fat, low cholesterol, high protein dietary structure, avoid eating brain, liver, kidney, fish and fried food, moreover, avoid eating fatty meat, avoid drinking alcohol, so as not to affect the function of the liver, or cause bile duct stones.
(3) Appropriate participation in physical exercise and light physical labor, avoid sitting and lying for a long time, too little activity, in order to facilitate the recovery of muscle function. Within two to three months after surgery, you can do activities such as walking to promote the recovery of the body.
(4) Regular review Take medication as prescribed by the doctor and follow up regularly at the hospital, and consult the doctor promptly in case of any discomfort.
Specific dietary considerations
(1) According to the symptoms and the degree of tolerance to fat, do not consume too much fat, and advocate cooking with vegetable oil.
(2) On the basis of meeting the patient’s needs, the total caloric energy should not be too high. Obese and overweight patients should lose weight to bring it down to the ideal weight. Calories should be supplied according to the principles of low-calorie diet.
(3) Restrict the intake of cholesterol. Cholesterol intake should be less than 300 mg per day, limiting animal fat and foods containing high cholesterol, such as offal and fish roe, egg yolk, etc.. Fish, lean meat, egg whites, etc. can be used.
(4) Protein should be at normal requirement or low, with a daily supply of 50g-70g of protein as appropriate, but choose protein foods with low fat content, such as skim milk, egg whites, sea fish, etc.
(5) Pay attention to the intake of vitamins and trace elements.
(6) Eat less and more meals and drink more water.