Cholecystectomy, the surgical removal of the gallbladder (GB), is a common procedure primarily performed to address gallstone diseases. These diseases include the development of gallstones, which can lead to symptoms such as nausea, vomiting, and abdominal pain. The gallbladder, a small organ located beneath the liver, serves as a reservoir for bile, a digestive fluid produced by the liver. Bile acids (BAs) produced by the liver are primarily stored and concentrated in the GB. The GB releases bile into the small intestine to aid in the digestion of fats. After cholecystectomy, the body's ability to digest lipids is somewhat reduced due to the absence of the GB. Post-cholecystectomy syndrome (PCS) can occur when abdominal symptoms manifest after surgery.
Understanding the Gallbladder's Role
The gallbladder plays a key role in digesting fats. This pear-shaped organ, located beneath your liver, helps your body digest fats and lipids. It stores and concentrates bile, which is slowly released during mealtime. Bile is a special fluid that your body makes in the liver, and it aids in digestion. In particular, it helps emulsify fats, oils, and lipids in food so they can be digested and absorbed into your body. Cholecystokinins released by the duodenum trigger GB contractions to release bile during fasting. Bile salts and BAs aid in the absorption of dietary lipids. Changes in the metabolic balance of BA post-cholecystectomy can result in increased reabsorption of BA and enterohepatic circulation.
Why Dietary Changes Are Necessary After Gallbladder Removal
After having your gallbladder removed, you’ll also likely experience changes in your digestion and will need to carefully watch your diet, at least in the beginning. But without a gallbladder, bile flows directly from your bile ducts into your digestive system - a direct route, without a gallbladder layover along the way. Your intestinal tract no longer has a gallbladder that can reabsorb, collect, and hold the bile in a safe storage space until you eat. Without it, there can be a bit of a learning curve for your body. Now, your body has to adjust to processing bile without a gallbladder. But bile can have a laxative effect (translation: It can make you poop), so you may have diarrhea for a few days or weeks afterward. But your post-surgery eating habits can lessen the likelihood of tummy troubles.
Common Post-Cholecystectomy Symptoms
Some individuals may experience mild discomfort or alterations in bowel patterns, especially after consuming high-fat meals. PCS has been reported to affect 5% to 40% of individuals following cholecystectomy. Symptoms may encompass an upset stomach, nausea, vomiting, gas, bloating, diarrhea, or persistent pain in the upper right abdomen. It is believed that these symptoms are not caused by, but rather exacerbated by the cholecystectomy. Furthermore, patients may also experience symptoms of gastritis as a result of duodenal-gastric reflux of BAs. This reflux may also contribute to the symptoms of PCS. Gallstones blocking the bile ducts are a common culprit behind cholecystitis, an inflammation of the GB. The buildup of bile in the GB due to obstruction by gallstones triggers inflammation and swelling. Cholecystitis can also stem from blockages in the cystic or bile ducts, in addition to gallstones. Tumors, narrowing of the bile ducts (strictures), or pressure from surrounding structures can all be contributing factors in these blockages. In some cases, cholecystitis might be caused by a GB infection. When bile becomes stagnant due to blockage, it can lead to inflammation and infection, potentially resulting in bacterial infections.
Types of Cholecystectomy
There are two primary types of cholecystectomy: laparoscopic and open cholecystectomy. In a minimally invasive laparoscopic cholecystectomy, small abdominal incisions are made. A laparoscope, which is a tiny, flexible tube with a light and camera, is then inserted through a single incision, allowing the surgeon to view the area on a monitor. Following this, small incisions are made, and specialized instruments are utilized to remove the GB. On the other hand, open cholecystectomy is a traditional, open procedure that involves a wider incision in the abdominal wall. Nowadays, open cholecystectomy is less common and is typically reserved for cases in which laparoscopic surgery is not feasible or when complications occur.
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Immediate Post-Operative Diet: Focusing on Clear Liquids
In the days right after surgery, stick with clear liquids, broths, and gelatin. After that, gradually add more solid foods back into your diet. Known as a clear liquid diet, this short-term, medically recommended diet helps your digestive system recover after surgery. It’s not nutritious or sustainable for longer than a few days, but it’s important to give your body a break to start healing. One important caveat: Sometimes, a clear liquid diet includes foods like coffee, soda, and juice. But when you’re recovering from gallbladder surgery, it’s best to avoid these.
Transitioning to Solid Foods: Bland and Low-Fat is Key
When you’re recovering from gallbladder removal surgery, you want foods that are easy for your body to digest. Sticking with soft, bland, low-fiber foods is the best way to rest your gut. If you’re sensitive to dairy, go lactose-free during this time period, too. Following this eating style for a few days after gallbladder removal can help ease your body back into digestion. Slowly add small amounts of foods back into your diet to avoid issues like diarrhea, cramping, and bloating.
Foods to Avoid After Gallbladder Removal
Most people can return to a regular diet within a month after surgery. But there are some foods you should stay away from in the immediate aftermath.
- Some beverages: Right after surgery, steer clear of alcohol, caffeinated drinks, and soda. Ditch these drinks for now and focus on drinking enough water, which will keep you hydrated and help your body heal.
- High-fat foods: More than half of patients who have their gallbladder removed have trouble digesting fat. After surgery, stick to a balanced and nutritious diet that focuses on whole foods and steers clear of high-fat foods.
- Spicy foods: While you’re giving your body a break from foods that could cause you an upset stomach, take it easy on spicy foods. Spicy foods can irritate your stomach lining and cause gastrointestinal issues stomach pain and diarrhea.
- High-fiber foods: Again, too much fiber right after gallbladder surgery can cause digestive issues, which are the last thing you want when you’re recovering from abdominal surgery. Fiber is a critical element of a healthy diet, so it’s important to (slowly) get back on the fiber bandwagon as you start to heal from surgery.
Specific Foods to Limit or Avoid
After surgery, stick to a balanced and nutritious diet that focuses on whole foods and steers clear of high-fat foods that fall into three categories: ultra-processed foods, full-fat dairy products, and high-fiber foods.
- Ultra-processed foods, including: Fast food, fried food, pizza.
- Full-fat dairy products, such as: Whole milk, butter, cheese, creamy soups and sauces, ice cream, yogurt.
- High-fat meats, like: Beef, skin-on poultry, processed meats like bologna, sausage, and deli meats, meat gravies.
- Scale back on fatty cooking oils, too, including: Coconut oil and palm oil. Even olive oil, which is considered the healthiest cooking, can upset your stomach right after gallbladder surgery.
- In the first few weeks, avoid fiber-filled food like: Whole-grain foods, nuts and seeds, beans and other legumes, Brussels sprouts, cruciferous vegetables like broccoli, cauliflower, and cabbage.
Gradually Reintroducing Foods and Monitoring Tolerance
As your body is reconfiguring its digestive process, it’s best to eat smaller, more frequent meals - think four to six scaled-down meals instead of three larger ones. Focus on healthy foods like lean meat, low-fat dairy, and fruits and veggies. Slowly incorporate high-fiber foods.
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Additional Eating Tips
- Small, Healthy Portions: No feasts right after gallbladder surgery! As your body is reconfiguring its digestive process, it’s best to eat smaller, more frequent meals - think four to six scaled-down meals instead of three larger ones. Focus on healthy foods like lean meat, low-fat dairy, and fruits and veggies.
- Slowly Incorporate High-Fiber Foods: Fiber is important for helping your body digest food, but immediately after gallbladder removal, the effects of anesthesia and surgery can make high-fiber foods hard to digest. Take it slowly as you reintroduce high-fiber foods. Re-introducing things too quickly can lead to diarrhea, cramping, bloating, and gas.
- Keep a Food Journal: Consider keeping a food journal to track what you eat and how you feel, noting symptoms like abdominal pain, gas, diarrhea, constipation, etc. This log will help you understand what you can and cannot eat comfortably. As time goes on, take note of your tolerance for high-fiber foods and fats, especially healthy fats.
Addressing Persistent Symptoms and Seeking Medical Advice
Most people can return to a regular diet within a month after gallbladder removal surgery, but some people have to make long-term changes. Talk to your healthcare provider if you:
- Experience persistent, worsening, or severe abdominal pain
- Have severe nausea and/or vomiting
- Notice a yellowing of your skin and eyes (jaundice)
- Have diarrhea that lasts more than three days after surgery
- Can’t poop for more than three days after surgery
- Can’t pass gas (fart) more than three days after surgery
In rare instances, some people’s bodies don’t adapt well to gallbladder removal.
The Role of Dietary Fat Intake: Conflicting Evidence
After cholecystectomy, there is no universal standard for medical nutrition therapy (MNT). MNT should be tailored to the individual patient's needs, and various dietary adjustments may be necessary. It is recommended to restrict fat intake for a few months to allow the liver to adjust to the absence of the GB. In a study conducted by Blasco et al., dietary changes were made to target the fat content in 83 patients who had cholecystectomy. The study found that there was no discernible difference in the impact of low-fat content on the rate of improvement of post-operative symptoms. As the GB is an organ of storage rather than bile production, there is currently no good reason to restrict a patient's diet during the post-operative phase of a cholecystectomy. On the other hand, de Menezes et al. conducted a study on post-cholecystectomy patients, recommending a low-fat diet. They concluded that a low-fat diet was not associated with gastrointestinal symptoms. According to the authors, diets should be customized according to individual needs. The debate among surgeons about whether these patients should follow a low-fat diet following surgery remains a cause for debate. There are currently no scientific studies that demonstrate whether a low-fat diet is effective after a cholecystectomy.
Research Findings on Dietary Factors and Post-Cholecystectomy Syndrome
Öztepe et al. found that after laparoscopic cholecystectomy, symptoms worsened with the consumption of processed meats, full-fat cheese, some fruits and vegetables, snack foods, sauces, and fried, high-fat foods.
Potential Metabolic Changes After Gallbladder Removal
Individuals who have dyslipidemia are more likely to develop gallstone disease, which can especially occur in those whose triglyceride metabolism is impaired. A well-established pathophysiologic component connected to obesity. However, the GB does more than just store and concentrate BAs; it may also have an impact on how nutrients, particularly lipids, are metabolized, which, in turn, affects how much of these nutrients are present in the blood. As a result, the removal of this organ is likely to cause metabolic changes that could change the biomarkers' serum levels. Goodarzi et al. did a study on 70 patients who evaluated the daily dietary consumption, and the study revealed that by the 30th day following surgery, cholecystectomy lowers high-density lipoprotein cholesterol (HDL-C) levels; however, lipoproteins, weight, and BMI did not change substantially.
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