Long-term side effects after cholecystectomy can include the following.
1. Indigestion, bloating and diarrhea.
In addition to the functions of storage, concentration and contraction, the gallbladder also has complex chemical and immune functions. Bile is secreted by hepatocytes through the intra- and extra-hepatic bile ducts along the cystic duct, into the gallbladder for storage and concentration. The concentrated bile is 30 times more concentrated than the bile secreted by the liver and is reserved for high-fat meals and is discharged into the intestine to participate in digestion. If the gallbladder has been removed, this part of the highly concentrated bile will be lost, and the body will have to tolerate indigestion when eating high-fat food, resulting in bloating and diarrhea.
2, after cholecystectomy duodenal fluid reflux to the stomach, gastric fluid reflux to the esophagus.
In recent years, this kind of report has increased significantly, and at the same time there are also relevant experimental control studies to confirm. The reason is that the loss of bile reserve function after cholecystectomy leads to the continuous excretion of bile into the duodenum from intermittent and feeding-related excretion, which increases the chance of reflux into the stomach and leads to bile reflux gastritis or esophagitis, which brings a lot of pain to patients.
3.The effect of cholecystectomy on the incidence of colorectal cancer.
In recent years, many European scholars found that among the cases of colon cancer, many of them have a history of cholecystectomy, and some scholars pointed out that the risk of colon cancer after cholecystectomy is 45 times higher than that of cases without cholecystectomy. Animal experiments have shown that secondary bile acids can directly increase the occurrence of colon cancer in animals; controlled studies have found that cholecystectomy can increase the proliferative activity of intestinal mucosa, thus contributing to the occurrence of cancer.
It is the change in the quality and quantity of bile after gallbladder removal that is the main cause of colorectal carcinogenesis. The bile acid secreted from liver is primary bile acid, which enters the intestine and comes into contact with bacteria, and becomes secondary bile acid in increased amount; after the loss of gallbladder function after cholecystectomy, primary bile acid continuously flows into the intestine and comes into contact with bacteria 24h, thus producing a large amount of secondary bile acid; the concentration of secondary bile acid in the colon, so the cancer species after cholecystectomy is more likely to occur in the right half of the colon.
Therefore, it is generally believed that the mechanism of promoting colon cancer after cholecystectomy is that more bile circulation after cholecystectomy affects the degradation of bacteria, resulting in higher content and proportion of secondary bile acids in the bile salt pool, and secondary bile acids have carcinogenic or synergistic carcinogenic effects, so colon cancer is likely to occur.
4.The problem of medically induced bile duct injury after cholecystectomy.
In the surgical procedure of cholecystectomy, due to the importance of Calot’s triangle and the influence of local tissue adhesions, there is always a certain probability of comorbidity brought about by cholecystectomy (bile duct injury: 0.18%~2.3%); and there is a certain mortality rate. In particular, it is worth emphasizing that the majority of cases of bile duct injury are caused by cholecystectomy. Huang Xiaoqiang statistics 2566 cases of CBD injury, 1933 cases caused by cholecystectomy, accounting for 75% of stenosis cases.
In the United States, for example, about 500,000 gallbladder resections are done each year; so there will be thousands of cases of bile duct injury each year; China’s large population, gallbladder stone cases should be above the United States; and the complications of bile duct injury is a very difficult subject of biliary surgery.
5.Post cholecystectomy syndrome.
In the past, the term “post-cholecystectomy syndrome” was a vague concept; with the progress of modern diagnostic imaging technology, the diagnosis of residual stones and bile duct injury after biliary surgery has been excluded, and only the inflammation and dyskinesia of the sphincter of Oddi that occurred after biliary surgery can be called “postoperative syndrome”. Only the inflammation and dyskinesia of the sphincter of Oddi after biliary surgery can be called “postoperative syndrome”, and the treatment of this symptom is clinically difficult.
6. Increased incidence of common bile duct stones after cholecystectomy.
In the analysis of the causes of primary stone formation in CBD, one of the important theories is the principle of “fluid mechanics”. After removal of the gallbladder, the gallbladder loses its buffering effect on the fluid pressure in the bile duct, resulting in an increase in the pressure in the common bile duct, which causes compensatory dilation of the common bile duct, which in turn slows down the bile flow in the common bile duct and causes vortex or eddy flow, the latter being an important theory for the formation of gallstones.
The function of gallbladder is normal in most of the patients with gallbladder polyps, so for a small benign polyp, the gallbladder is easily removed and the function of gallbladder is lost, inviting all kinds of maladies after cholecystectomy, which is a big taboo in modern surgery and should be done with caution.
There is a world of difference between biliary and cholecystectomy in the treatment of gallbladder polyps, endoscopic biliary polyps preserve the physiological function of the gallbladder; cholecystectomy loses the gallbladder and the physiological function of the gallbladder, which can cause a series of physiological disorders, and even the possibility of colon cancer; biliary polyps are very safe, and there is no possibility of those complications of cholecystectomy, and there is no mortality rate so far.
After removal of the gallbladder, of course, there is no possibility of recurrence of gallbladder polyps; however, the risk of increased incidence of common bile duct stones is raised; but which one is better? With the development of modern medical science and technology, there is a better understanding of the gallbladder as an important digestive organ, which is a complex organ with chemical and immunological functions, in addition to the role of concentration, contraction and regulation of the buffer bile duct pressure.
It is not a dispensable gallbladder, but a very important digestive organ, so it should not be easily abolished! Of course, for the gallbladder atrophy, the gallbladder is no longer functional, or the gallbladder is suspected of cancer, there is no doubt that the gallbladder should be removed to remove the lesion.