What is life like after gallbladder removal

Long-term effects of gallbladder removal include diarrhea, fatty food intolerance, gas, heartburn, nausea, vomiting, jaundice, and intermittent episodes of abdominal pain. Symptoms of post-cholecystectomy syndrome typically begin in the postoperative period, but can also begin months or years after surgery.

Lifestyle adjustments, including avoiding fried, fatty, spicy, or acidic foods and keeping a food and symptom journal, often help to resolve the issue. Some people may require subsequent surgery to resolve issues.

This article discusses the long-term effects of gallbladder removal. It also discusses potential treatments for the symptoms of post-cholecystectomy syndrome.

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.

Post-Cholecystectomy Syndrome

Having adverse symptoms after gallbladder surgery is referred to as post-cholecystectomy syndrome.

People with post-cholecystectomy syndrome may develop new symptoms or symptoms similar to those they experienced before surgery. These long-term effects of gallbladder surgery may appear just after surgery, but can also develop months or years later.

Adjustments to your diet and eating habits may help relieve these problems. In some cases, a second surgery may be needed to resolve symptoms, which may include:

• 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 long-term effects of gallbladder surgery caused by residual gallstones must undergo a second surgical procedure to remove those 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, which 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).

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 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.

Many of those who do experience negative symptoms such as indigestion and diarrhea after gallbladder surgery are able to get relief by simply changing their diet.

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)

What to Eat After Gallbladder Removal

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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