Gallbladder Surgery Long-Term Care

In This Article

Gallbladder surgery can be successful in treating gallstones, but a significant number of people have adverse symptoms known as post-cholecystectomy syndrome. Adjustments to your diet and eating habits may help relieve these problems. In some cases, a second surgery may be needed to resolve these symptoms. As well, people who have gallbladder surgery to address cancer also have differences in outcomes.

gallbladder surgery long-term care
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Benefits of Surgery

The number one reason for gallbladder surgery—gallstones—results in one of the most commonly performed elective abdominal surgeries, worldwide, namely, laparoscopic cholecystectomy (LC).  A cholecystectomy is the removal of the gallbladder. In fact, there are 700,000 laparoscopic cholecystectomies in the U.S. each year.

A 2019 systematic review found that over half (60%) of the people who had their gallbladder removed did not experience any adverse symptoms after surgery and went on to live a normal, healthy life. The pain caused by gallstones completely subsided in this population.

Many of those who experience negative symptoms such as indigestion and diarrhea after gallbladder surgery are able to get relief by simply changing their diet. The study authors point out that if you are having any discomfort or digestive problems after gallbladder surgery, it’s best to get treatment right away instead of waiting to see if the symptoms improve on their own.

Possible Future Surgeries

There are several common conditions and symptoms that can surface after a person has gallbladder surgery, and some may require a subsequent surgical procedure. Common conditions that may occur after a cholecystectomy include newly formed or residual gallstones.

Post-Cholecystectomy Syndrome

Having adverse symptoms after gallbladder surgery is referred to as post-cholecystectomy syndrome. Post-cholecystectomy syndrome is a loose term pertaining to adverse symptoms experienced after a gallbladder removal procedure. Post-cholecystectomy syndrome includes symptoms of:

  • Fatty food intolerance
  • Nausea
  • Vomiting
  • Flatulence (gas)
  • Indigestion
  • Diarrhea
  • Jaundice (yellowish tinge to the skin and whites of the eyes)
  • Episodes of abdominal pain

According to a 2018 study, having a cholecystectomy did not relieve a person’s symptoms in as many as 40% of those who had the surgery. This translates to nearly 280,000 people (out of a total of 700,000) each year who do not experience a complete absence of symptoms after gallbladder surgery.

A systematic review of those with long-term post-cholecystectomy syndrome was conducted to guide providing treatment for this population. In this study, gallstones that did not get removed the first time a cholecystectomy was performed (as well as new gallstones that formed after the initial gallbladder surgery) accounted for up to 23% of post-cholecystectomy symptoms.

Many people who experience post-cholecystectomy symptoms caused by residual gallstones must undergo a second surgical procedure to remove the gallstones that were left behind. Residual gallstones are commonly found in the common bile duct (CBD). 

Gallbladder Remnant

Sometimes a portion of the gallbladder is left behind during a cholecystectomy; this is called a gallbladder remnant. When a person has a gallbladder remnant, gallstones can continue to form in the gallbladder, requiring a subsequent surgical procedure to remove the remnant.

According to a 2018 study, incomplete removal of the gallbladder after an open or laparoscopic cholecystectomy is the most common reason for abdominal pain, indigestion, and jaundice after a gallbladder removal procedure.

Cystic Duct Stump

Another surgical procedure that is sometimes performed after a cholecystectomy is called an "excision of a cystic duct stump with stone." But this condition is considered a rare cause for post-cholecystectomy syndrome. Once the gallbladder is removed, the cystic duct is no longer needed and it is usually detached at a point that is very close to where it joins the common bile duct.

Sometimes a very small portion of the cystic duct is left behind, this is referred to as a cystic duct stump. A cystic duct remnant is a term used when the size of the cystic duct following cholecystectomy is more than or equal to 1 centimeter (0.39 inches).

The cystic duct is approximately 1.5 inches long. It’s part of the biliary system that functions to allow bile to travel from the liver to the small intestine. The biliary system is a collection of tubular shaped structures called bile ducts. The bile ducts lead from the liver to the gallbladder, then empty into the small intestine (where bile works to help digest and absorb ingested fats).

Long-Term Outcome of Gallbladder Cancer

Another indication for gallbladder surgery is to remove a tumor. A 10-year study looked at the long-term results for people who had surgery for cancer of the gallbladder.

Some of the people who participated in the study were diagnosed with cancer before they underwent the first cholecystectomy, others were diagnosed intraoperatively (during the gallbladder surgery). Others yet were diagnosed after the tissue from the gallbladder (after the cholecystectomy) was sent to the pathology lab for examination.

The study authors discovered that the overall average survival rate differed, depending on when the cancer was diagnosed, for example:

  • Of those in the study where the cancer was diagnosed intraoperatively (during the cholecystectomy) and the cancer was advanced and considered irresectable (unable to be removed by surgery), these study participants had an average survival rate of one month.
  • Of the study participants who were diagnosed before they underwent cholecystectomy, none experienced curative operations. 
  • Of those diagnosed incidentally (as a result of pathology examination of the gallbladder tissue), the average survival rate was 38 months. 
  • Four of the study participants who were incidentally diagnosed underwent a surgical procedure called a radical re-section after their initial cholecystectomy. All four were considered curative.  

Note, those who had symptoms of jaundice (yellowish tinge to the skin and eyes) had worse outcomes in the study than those who had normal bilirubin levels.

Lifestyle Adjustments

After gallbladder surgery, long-term care is usually minimal; most people live a perfectly normal life without a gallbladder because the liver can still produce enough bile to breakdown ingested fats in the diet. The primary difference is that instead of simply getting a bolus of bile after a large meal is ingested, people who have undergone a cholecystectomy have a continuous drip of bile from the liver into the duodenum (the first part of the small intestine).

Although it has not been proven in clinical research studies, some experts point to the probability that this continuous flow of bile acids into the small intestine may be attributed to symptoms of dyspepsia (indigestion), may increase the risk of gastritis (inflammation of the stomach) and may cause duodenal (small intestine) gastric (stomach) reflux. Reflux occurs when the contents of the stomach or bile rise up and irritate the lining of the esophagus.

If you experience digestive problems such as bloating or diarrhea, these symptoms should not be long-term, but rather should subside within a few weeks after surgery.

Diet

After gallbladder surgery, it's a good idea to keep a food journal or keep notes in a diet app, that way if a certain food or ingredient cause symptoms, you can take note of it and avoid that specific food in the future. After your gallbladder surgery, pay very close attention to how your digestive system responds to the foods you eat, foods that are commonly problematic include:

  • Fatty or fried foods
  • Spicy foods
  • Acidic foods

Be sure to include in your journal how much of each food you eat, that way you can initially try reducing the amount of a problematic food, to see if eating less helps, before completely eliminating the food from your diet. Again, be aware that many of these food intolerances are temporary, so you can try to re-introduce problematic foods later on.

If you experience ongoing symptoms, it’s important to consult with your healthcare provider to be evaluated for any underlying physiological problems that could be causing adverse symptoms, including:

  • Indigestion
  • Bloating
  • Flatulence (gas)
  • Diarrhea

If you do experience adverse symptoms, diet interventions include:

  • Avoid coffee, tea, and other caffeinated beverages
  • Avoid any foods that worsen symptoms such as fatty or spicy foods
  • Gradually increase the amount of fiber you eat (such as fruits, vegetables, and whole grains)

Diarrhea

A few people who have had gallbladder surgery experience persistent diarrhea. If you have diarrhea, you can ask your healthcare provider if there is a type of medication (over-the-counter or prescription) that is recommended.

A Word From Verywell

Although you may be under the impression that there are no long-term after-effects of gallbladder surgery, many people do experience some chronic problems; 40% of those observed in a 10-year follow up study did, in fact, have some residual effects.

Many times, residual symptoms of a cholecystectomy, do not require a person to have an additional surgical procedure. Rather, a lifestyle change (such as a simple change in diet) could be all that is needed. If you are experiencing symptoms after your gallbladder surgery, be sure to consult with your healthcare provider; it’s important to rule out any serious underlying causes, in addition to adjusting your diet.  

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