Gallstones, also called biliary system stone disease or cholelithiasis, is one of the common diseases in hepatobiliary surgery. The gallbladder, common hepatic duct and common bile duct together form the biliary system of the body to perform the functions of transporting, storing, concentrating and excreting bile. If the structure of the biliary system or the composition of the bile changes, solid crystals may form anywhere in the biliary system, which are known as gallstones. If the gallstones are very small, the patient usually does not feel it obviously; if the gallstones are larger, the patient will have fever, chills, nausea, vomiting, abdominal pain and other symptoms, and it can also cause jaundice, cholangitis and pancreatitis, and even gallbladder cancer. Therefore, all patients who meet the indications for surgery (symptomatic gallbladder stones, asymptomatic people with stones larger than 2-3 cm, filled gallbladder stones, atrophic gallbladder, and porcelain gallbladder) should be treated as early as possible. I have seen too many patients who are reluctant to undergo surgery for gallbladder stones during physical examination, and when they are willing to undergo surgery again, they are found to have gallbladder cancer, which is a pity.
Surgical removal is the most reliable treatment for gallbladder stones
At present, the mainstream methods of gallbladder stone treatment include cholecystectomy, other methods include biliary lithotomy, oral lithotripsy and lithotripsy treatment. Among them, oral drug lithotripsy and extracorporeal ultrasonic lithotripsy have been eliminated due to unsatisfactory efficacy, and surgery has become the safest and most effective method to treat gallstones, and minimally invasive cholecystectomy and cholecystectomy were then produced. Around 1990, there was a treatment boom of biliary stone extraction at home and abroad, but because of the abnormal cholesterol metabolism of gallbladder stones by biliary stone extraction, the recurrence rate of stones after surgery was too high. Laparoscopic cholecystectomy has become the gold standard for gallbladder stones at home and abroad because of its precise efficacy and small trauma, and is now the first choice of treatment in all major hospitals.
There is little significance in preserving the diseased gallbladder
The impact of gallbladder removal on human health is minimal. Because bile is secreted by the liver, the gallbladder only plays a storage and concentration function, and there is no significant change in the original bile secretion after removal of the gallbladder. There is a view that gallbladder resection is prone to disadvantages such as biliary dysfunction, postoperative intestinal obstruction, colon cancer, postoperative diarrhea, reflux gastritis and reflux esophagitis. However, in clinical practice, it is found that except for less than 5% of patients who are prone to increased stool frequency after eating a high-fat diet after surgery, the remaining manifestations are very rare, especially the fallacy of increased risk of colon cancer has been recognized by the medical community, and generally after 1 year, most patients’ diarrhea can disappear through self-regulation. In fact, with gallbladder stones, a large proportion of patients no longer have a concentrating function of the gallbladder.
Stones are prone to recurrence after gallbladder preservation surgery
If the gallbladder has been removed, it is impossible to have gallbladder stones again, as the saying goes, “If the skin does not exist, the hair will not be attached. The recurrence rate of stones 2 years after gallbladder preservation is reported to be between 40% and 80% at home and abroad, and most patients will be forced to undergo a second operation, which will be more difficult and dangerous because of the adhesions that occurred after the first operation. This shows that there is little need for gallbladder patients to insist on the choice of gallbladder preservation surgery.
Diet after cholecystectomy/cholecystectomy, bile duct exploration
After removal of the gallbladder, the organism loses the gallbladder’s functions of storage, concentration, bile secretion and secretion. The problem manifested in the fat digestion function is that no concentrated bile enters the small intestine, the concentration of bile acids in the intestine decreases, and the content of bile salts is reduced by half compared with normal people. If the fat content of the ingested food is high, it will cause fat indigestion and affect the absorption of fat-soluble vitamins, after a period of time the body will gradually adapt and compensate, and this process takes 2 to 3 months. Therefore, during this period of adaptation, the intake of fat should be limited, especially 1 time can not eat food containing too much animal fat. Generally, we use the method of eating less and more meals, and one meal should not be too full. Food content can be low-fat semi-liquid or low-fat soft meals, such as various kinds of porridge, noodles, bread, cookies, tofu, egg whites, fat-free milk, low-fat lean meat, low-fiber vegetables and fruits, etc. Cooking by stewing, steaming or boiling is appropriate. According to the tolerance of food, after a period of adaptation after surgery, then gradually liberalize the intake of fatty foods.
Main causes of diarrhea after cholecystectomy
Many patients with cholecystitis and cholelithiasis often have unformed, thin stools or even diarrhea for 3-6 months after cholecystectomy. The symptoms are more severe if they eat fatty foods. This condition is medically called “fatty diarrhea”. So, why do patients with cholecystitis and cholelithiasis have diarrhea after gallbladder surgery? This is because bile is secreted by the liver, which secretes about 800-1,000 ml of bile every day. At the same time, the gallbladder also has the function of storing and concentrating bile.
However, after the gallbladder is removed in patients with cholecystitis and cholelithiasis, the bile secreted by the liver flows directly into the common bile duct and enters the small intestine. When people eat, their digestive ability, especially the ability to digest fat, is significantly reduced because the intestine lacks a sufficient amount of highly concentrated bile to help digestion and absorption of fat. As a result, some of the poorly emulsified fatty food is excreted in the feces, at which point 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, which is also an irritant to the empty, food-free intestine and can cause diarrhea or unformed stools.
After gallbladder removal, the body gradually undergoes some compensatory changes to adapt to the needs of digestion. During this compensatory and adaptive time, the digestion and absorption of fats will be temporarily affected to some extent. After 3-6 months, according to the body’s reaction to fatty food, gradually increase some fatty food until the normal amount is maintained. If there is discomfort or diarrhea, then reduce some or temporarily do not eat fatty foods for a few days as appropriate.
Some people interpret “less fatty food” as less animal fat and no restriction on vegetable oil. In fact, this will also produce the same symptoms. Because whether it is vegetable fats or animal fats, the digestion and absorption in the intestine must be involved in bile. Therefore, if too much vegetable oil is eaten at one time, the symptoms caused are the same.
Life care after cholecystectomy
The gallbladder is the place where bile is stored in the human body, constantly storing and concentrating the bile secreted by the liver, and when eating, the gallbladder discharges the concentrated bile into the duodenum by its own contraction 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, bile will continue to enter the duodenum, and when people eat, they will not get enough bile to help digestion, resulting in symptoms of indigestion, such as abdominal discomfort, bloating, diarrhea, etc.
After surgical removal of the gallbladder, patients can obtain their own regulatory compensation after a period of adjustment and recovery, that is, through compensatory dilation of the bile ducts to effectively maintain the normal physiological functions of the body. As the regulation of compensatory function after gallbladder removal needs a certain period of 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, etc. 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 expand and will partially replace the role of the gallbladder, and the symptoms of indigestion will slowly ease. At this time, the diet can also be gradually over to normal.
2, resume a normal diet, it is advisable to maintain a low-fat, low cholesterol, high plant protein dietary structure, avoid eating brain, liver, kidney, fish and fried food, should not eat fatty meat, avoid drinking alcohol, so as not to affect the function of the liver, or cause bile duct stones.
3, pay attention to mental health, often maintain emotional stability, optimism and open-mindedness, to avoid anger, anxiety, depression and other adverse emotions, in order to prevent the central nervous and plant nerve regulatory function disorders, affecting the recovery of bile duct compensatory function.
4, appropriate participation in physical exercise and light physical labor, avoid prolonged sitting and lying, too little activity, in order to facilitate the recovery of muscle function. Within two or three months after surgery, you can do activities like walking to promote the recovery of the body.