Removal of the gallbladder or cholecystectomy is an operation that significantly affects the characteristics of digestion and requires adjusting the diet. In a healthy person, bile is synthesized by the liver and enters the gallbladder through the ducts. In it, there is a thickening or concentration of bile. When eating, the gallbladder secretes through the ducts into the duodenum the amount of bile required to ensure normal digestion.
Cholecystectomy significantly changes the digestive process. The bladder is removed, and bile enters the duodenum directly from the liver through the intra- and extrahepatic bile ducts. As a result, bile of a different composition enters the intestinal lumen. This negatively affects peristalsis and leads to disruptions in the digestive process. Such bile is relatively liquid, it does not adequately protect the intestines from microorganisms, which leads to an increased risk of dysbiosis.
Nutrition rules after removal of the gallbladder
The main goal of a proper diet after removal of the gallbladder is to normalize bile secretion and digestion of food. To avoid the adverse consequences of the operation, it is necessary to adjust the food intake and the diet itself.
- More frequent food intake (4-5 times a day) reduces the burden on the digestive system.
- A significant decrease in the intake of fatty foods after cholecystectomy is designed to prevent spasm of the pylorus and sphincter of Oddi and the development of symptoms: bitterness in the oral cavity, nausea, discomfort in the right hypochondrium, pain in the hypochondria.
- People who have had their gallbladder removed should eat predominantly low-fat foods that are cooked without frying. Protein and plant foods, steamed and boiled or baked, are the basis of the diet of people who have undergone cholecystectomy. Rehabilitation of patients after cholecystectomy is based on these principles of therapeutic nutrition. Don’t be alarmed: this is a healthy diet that all people should generally adhere to!
Non-compliance with diet – consequences
After removal of the gallbladder, the secreted bile is enough to digest a much smaller volume of food, so overeating can have unpleasant consequences. Failure to comply with the diet prescribed by the doctor after cholecystectomy is fraught with the addition of other problems of the gastrointestinal tract (dysfunction of the intestines, stomach, esophagus, pancreas, etc.) with various complications: colitis, cholangitis, esophagitis, duodenitis and other diseases. Nutritional therapy is especially important for patients who have undergone cholecystectomy due to calculous cholecystitis.
Improper diet, high consumption of fried and rich in animal fats food can lead to the re-formation of gallstones already in the ducts.
Diet in the hospital
The length of hospital stay is largely determined by the technology of performing cholecystectomy. The gold standard in the treatment of cholecystitis is laparoscopic cholecystectomy. This type of operation is favorably distinguished by minimal trauma and a shorter hospital stay (usually 1-3 days). After laparoscopy, the patient’s recovery is relatively quick and painless, and the diet, both in the hospital and in the following weeks, is less conservative.
Unfortunately, laparoscopic cholecystectomy cannot always be performed due to the peculiarities of the course of the disease and the individual characteristics of the anatomical structure of the gallbladder and ducts. For this reason, the doctor is forced to resort to open (laparotomic) cholecystectomy. Depending on the degree of invasiveness of the operation, the length of stay in the hospital may increase (5-10 days or more). The increased invasiveness of this approach to gallbladder removal leads to more significant dietary restrictions in the first weeks after surgery.
After laparoscopic cholecystectomy, the patient spends 2 hours in the intensive care unit, recovering from anesthesia. Then he is transferred to the conditions of the ward, where appropriate postoperative therapy is carried out. For the first 5 hours, the patient is forbidden to get out of bed and drink. Starting in the morning of the next day, it is allowed to drink plain water in small portions (up to 2 sips every 15 minutes). You can get up about 5 hours after the operation. It is permissible to do this only in the absence of weakness and dizziness. The first attempts to lift should only be made in the presence of a nurse.
Starting the next day, the patient can move around the room and start eating. It is permissible to use only liquid food (oatmeal, kefir, diet soup). Gradually, the patient returns to his usual fluid intake – this is important for diluting the bile. For the first week after the operation, it is important to completely exclude the use of the following foods and drinks:
- strong tea
- sweet drinks
- fried food
- fatty food
- smoked, spicy, salted, pickled.
The patient’s diet in the hospital contains a variety of low-fat fermented milk products: yogurt, cottage cheese, kefir, yogurt. Also, buckwheat and oatmeal porridge in water, mashed potatoes, grated boiled lean beef, chopped white chicken meat, carrot soufflé, beetroot dishes, lean soups, bananas and baked apples are gradually introduced into the diet.
Diet in the first week after discharge from the hospital
Usually, after laparoscopic cholecystectomy, the patient is discharged already on days 1-3. At home, it is necessary to organize proper nutrition, taking into account the recommendations given at discharge. Food should be taken in small portions, 6-7 times a day. It is advisable to arrange meals on a specific schedule, this will reduce the load on the digestive tract. The last meal should be at least 2 hours before bedtime.
To normalize digestion, it is necessary to ensure that you drink plenty of fluids throughout the day (total fluid intake – 1.5 liters). The optimal drink is sterilized non-acidic juices with pulp, rosehip decoction and mineral water, the brand of which should be agreed with the doctor.
In the first week after discharge from the hospital, it is necessary to adhere to the therapeutic diet “Table No. 1” and avoid fresh vegetables and berries, rye bread, as these products increase bile secretion. The main emphasis in nutrition is on mashed meat, fish and vegetable dishes, steamed. Food should not be hot or cold.
Examples of dishes that can be consumed during this period:
- steamed chicken roll
- milk soup
- steamed meat soufflé
- cottage cheese casserole
- protein steam omelet
- low-fat yogurt or kefir
- buckwheat or oatmeal
- Adyghe cheese
The first days after surgery to remove the gallbladder, the diet is as limited and conservative as possible. On the 5-7th day – a smooth transition between surgical diets 1a and 1b (sometimes called 0b and 0c). A sample menu for one day for surgical diets 1a and 1b is shown below.
Sample menu for one day for the surgical diet 1a
- 1st breakfast: protein omelet from 2 steamed eggs, 200 g of chopped liquid oatmeal with milk and 5 g of butter and tea with lemon juice.
- 2nd breakfast: zero fat cottage cheese and 100 g of rosehip broth.
- Lunch: 50 g of steamed boiled meat soufflé, 200 g of mucous soup with semolina, 100 g of rosehip broth and 150 g of milk cream.
- Dinner: 200 g of chopped liquid buckwheat porridge with 5 g of butter, steam boiled fish soufflé and tea with lemon juice.
- Finishing meal: 100 g rosehip broth and 150 g fruit jelly.
- Total daily dose: 40 g sugar, 20 g butter.
Sample menu for one day for a surgical diet 1b
- 1st breakfast: 200 g of milk porridge from rice with 5 g of butter, a steam omelet from egg whites, sweet tea with lemon juice.
- 2nd breakfast: 100 g of chopped baked apples, 120 g of chopped cottage cheese with the addition of cream, 180 g of rosehip broth.
- Lunch: 100 g of steamed meat cutlets, 300 g of creamy soup with vegetables, 200 g of mashed potatoes, 150 g of fruit jelly.
- Afternoon snack: 180 g of fruit juice, 150 g of chopped boiled chicken.
- Dinner: 200 g of chopped milk herculean porridge with 5 g of butter, 100 g of steamed soufflé from boiled fish, tea with 50 g of milk.
- Finishing meal: 180 g of kefir.
- Total daily dose: 60 g sugar, 20 g butter, 100 g white crackers.
Diet in the first month (2-4 weeks after surgery)
The first month after surgery is especially important for restoring the normal functioning of the patient’s digestive tract and improving overall well-being. It is this period of time that is key for the normalization of the digestive functions of the body. Therefore, during its duration, it is necessary to carefully follow the recommendations prescribed by the doctor. These include not only nutritional requirements, but also a set of measures to ensure proper physical activity, drug therapy and wound care.
After laparoscopic cholecystectomy, dieting is usually necessary for 1 month. Then, in agreement with the gastroenterologist, relaxation in the diet can be made, the range of products consumed can be expanded, and dietary restrictions can be lifted.
With open cavity cholecystectomy, the period of severe dietary restrictions is longer than with cholecystectomy. Regardless of the type of operation performed during the first month, it is recommended to exclude from the diet:
- fried food
- fatty foods
- spicy and spicy food
- smoked meats
Also, during this period, it is recommended to completely abandon smoking, as it slows down the postoperative recovery of the body. Dishes should be slightly warm and cold or hot foods should be avoided. Regular meals are required 4–6 times a day, meals should preferably be taken at about the same time. The introduction of new products into the diet should be carried out gradually, carefully listen to the body’s reaction and, if necessary, consult a gastroenterologist.
From the second week, in the absence of complications, diet 5a is used. This is a variation of Diet 5, characterized by reduced chemical and mechanical effects on the digestive tract, which makes it preferred after cholecystectomy. This diet is very gentle – all foods are boiled or steamed. The 5a diet menu is based on boiled fish and meat, steamed cutlets, protein omelets, vegetable soups, steamed cottage cheese puddings, mashed potatoes, fruit jelly, chopped cereals in milk, stewed vegetables.
In case of poor tolerance of the 5a diet (bloating, diarrhea, pain in the hypochondrium), a 5sh diet can be prescribed, which is characterized by even greater delicacy in relation to the digestive system.
- First breakfast: half a serving of semolina in milk, tea, 110 g of a steam omelet made from egg whites.
- Second breakfast: rosehip broth, 100 g of fresh unleavened cottage cheese.
- Lunch: 100 g of boiled meat soufflé, half a serving of mashed soup with vegetables and oatmeal, 100 g of fruit jelly, 100 g of carrot puree.
- Afternoon snack: 100 g of baked apples.
- Dinner: half a portion of mashed potatoes, boiled fish, tea.
- Finishing meal: jelly or kefir.
- Total daily intake: 200 g of white bread, 30 g of sugar.
The diet should not contain hot seasonings, any smoked and spicy foods are prohibited. Food is taken warm; cold and hot foods should be avoided.
Diet one month after surgery
People who have undergone cholecystectomy are advised to adhere to the main diet option 5 for 1-1.5 years after surgery. After that, relaxation is possible, for example, switching to diet number 15, but an individual approach and consultation of a gastroenterologist is required. It is necessary to keep the consumption of sweets, animal fats, eggs, milk under special control.
In case of malfunctions in the digestive system, a review of the diet is required with the help of a doctor. In some cases, it is possible to return to the diet 5, 5a or 5sh. To improve the digestive processes, the attending physician may recommend the use of enzyme preparations, such as mezim-forte or festala.
There are a number of rules that should be followed throughout life for people who have undergone cholecystectomy:
- It is necessary to eat 4-5 times a day, to avoid long breaks between meals. It is advisable to train yourself to eat at about the same time.
- Portions should be small so that the diluted bile can handle the incoming food.
- Refractory animal fats should be completely excluded: pork, beef and lamb.
- The main methods of cooking should be boiling, stewing, and steaming.
- An abundant drink of 1.5–2 liters per day is shown.
- To avoid dysbiosis in the duodenum due to the absence of the gallbladder, regular use of fermented milk probiotics is desirable. The elimination of sweets also allows you to fight dysbiosis.
- When diarrhea worsens, avoiding coffee, tea, and other caffeinated beverages helps.
Below are the lists of foods allowed and prohibited for consumption after cholecystectomy.
List of Approved Products:
- stewed vegetables and vegetable purees
- steamed cutlets and meatballs
- boiled lean meat (chicken, turkey, rabbit, lean beef)
- boiled sausage
- a fish
- vegetable soups
- low-fat cabbage soup
- vegetable and fruit salads
- the vinaigrette
- whole milk
- dairy products
- vegetable fats
- some butter.
List of prohibited foods:
- fatty poultry (goose, duck)
- lamb, pork, other fatty meats
- hot spices
- smoked, fried and salty foods
- sweetened sodas.
We offer several recipes that can be used after 2 months from the date of cholecystectomy.
- Carrot salad with honey and raisins. Grate 100 g of fresh peeled, grate, add 10 g of washed raisins, place in a salad bowl, pour 15 g of honey, garnish with lemon slices.
- Fruit salad. Wash and peel the fruit (30 g kiwi, 50 g apple, 30 g banana, 30 g strawberries, 30 g tangerines). Cut the fruits, put in a salad bowl, season with 20 grams of 10% sour cream.
- Buckwheat soup with milk. Rinse with 30 g of buckwheat, pour 300 ml of hot water, boil, salt, add 250 ml of hot milk, 2 g of sugar and bring to readiness. Add 5 g butter.
- Boiled sea bass. Peel, wash, cut into small pieces and boil about 100 grams of perch in salted water. Add 5 g of parsley and 10 g of chopped carrots.
- Steamed haddock with butter. Peel, rinse and steam about 100 g of haddock. Drizzle 5 g of melted butter and sprinkle with 5 g of dill.
- Low-fat cottage cheese with lingonberries and sour cream. Grind about 100 g of low-fat cottage cheese, pour 20 g of 10% sour cream and sprinkle with 30 g of lingonberries with sugar.
- Boiled Brussels sprouts. Rinse about 250 g of Brussels sprouts ends and boil in lightly salted water. Drizzle with 10 g of butter before use.