Linda had just had her gallbladder taken out. The surgeon was able to do it laparoscopically, with the camera and the small holes, instead of through a bigger incision; and, after she had woken up in the recovery room, Linda realized the really bad pain in her upper right abdomen was a whole lot better. She was sore at the incision sites, but it was less than the pain she had experienced before the operation. Her doctor had discussed the plan for pain control with her before surgery, and she was glad to discover their expectations were reasonable, now that it was over. She still had questions, however. The first was quickly answered by the nurse, who brought her some water and juice to drink and told her she would be able to eat lightly within an hour or two. Linda was grateful to quench her thirst. When the surgeon came to speak with her again, she asked about her recovery period, and how she could get back to normal as quickly as possible.
Most of my patients achieve very manageable pain control by alternating acetaminophen and ibuprofen at regular intervals for the first few days postoperatively, and then as needed. These medications work on different pain pathways in the body and can be used together for a synergistic effect, providing greater pain relief than either one alone, and in many cases can even work better than a narcotic pill. If, after taking both a few hours apart, pain is still significant enough to require something stronger, a combination pill with acetaminophen and a narcotic (such as codeine, hydrocodone or oxycodone) may be prescribed to use instead of plain acetaminophen, as needed, for a few days only. Patients should not expect to have no pain at all, but to achieve a level of pain relief that allows them to walk, move, dress, wash, eat and accomplish simple tasks. As soon as their pain begins to decrease, I encourage using only over-the-counter medications, and only often enough to manage pain that interferes with daily activities or sleep. Linda did well with the alternating regimen, was able to decrease the number and frequency of both kinds of pills within several days, and by the end of the first week, only needed something occasionally to relieve mild to moderate discomfort.
After abdominal surgery, most patients are advised to limit heavy lifting and exertion for a period of time. This can range from a couple of weeks to a month or more, depending on the operation, the surgeon, and the patients usual activity level. In many cases, this precaution may be offered in the context of minimizing the patients risk of developing a hernia at an incision site. Realistically, any sudden and/or significant increase in intra-abdominal pressure has the potential to cause a weak point in the abdominal wall (like an incision) to separate, allowing fat or other abdominal contents to push through the opening, which we call a hernia. So, a cough or a sneeze could be just as bad as lifting something too heavy, especially early in the healing processbut we only have control over voluntary exertions. Doctors generally encourage deep breathing and coughing to clear ones airways, especially after abdominal surgery. So, patients are shown how to support or splint their bellies by holding their hands or a pillow firmly over their incisions while coughing, laughing, going to the bathroom, or during any activity where the abdomen wants to push outward and tends to hurt.
Activities which are limited in the early weeks after surgery may include things like gym workouts, weightlifting, sports, ab or core exercises (sit-ups, crunches, etc.) and heavy manual labor. Swimming or bathing, or submerging incisions underwater, are not allowed until skin incisions are healed. Showering after dressings are removed, however, is completely fine. Walking, climbing stairs and normal daily tasks are also not restricted. Driving is usually acceptable once you feel comfortable behind the wheel, can wear your seatbelt properly, are not using narcotics and would not hesitate because of pain to react immediately in an emergency situation.
Ultimately, your pain tolerance and comfort level are your best guide to resuming most activities after the first couple of weeks. Linda had family members help with the groceries, trash and laundry for a while, but listened to her body and was gradually able to return to her usual daily tasks. She saw the surgeon about 10 days after her operation and was no longer using pain medicine, was back to work at her sales job and able to enjoy time with her kids, although she wasnt ready to pick up her 3-year-old from the ground quite yet.
After surgery, I advise most patients to eat lightly at first, as they have been sick. Chicken soup, non-carbonated beverages, fruit, sandwiches, cereal or oatmealanything that settles well is a good start. Almost everyone can gradually resume their usual diet, even after removal of the gallbladder. The liver produces bile, which is a liquid that digests fats like oils, greasy foods, butter and other dairy products. The main bile duct, or tube, runs from the liver to the small intestine; it sends a constant flow of bile into the digestive system when we eat. If you eat a lot of fats in one meal, like a greasy burger and fries, the body signals the gallbladderwhich is a storage bag for bile off of the main ductto release extra bile into the system, and it squeezes out more to digest the extra fat. In some people, the bile solution is not in balance, and stones can form in the gallbladder when cholesterol or other substances come out of the solution. When the gallbladder tries to squeeze out extra bile, if a stone blocks the exit to the duct, it can cause pain and blockage of the bile system. This is one reason some people have their gallbladder removed.
Without a gallbladder, bile still flows from the liver to the intestine, and fats still get digested. But a meal which is very high in fat may overwhelm the system, since there is no longer a storage reservoir to provide extra bile. Early after gallbladder surgery, if a patient does eat too much fat in one meal, they may experience bloating, gas, cramps and diarrhea, as the undigested fat moves through the intestines. Most patients bodies slowly adjust to the absence of the gallbladder, and they are eventually able to eat much as they did before their surgery. But if they do overdo it with a fatty meal, it is easy to recognize and correct by moderating the fat content the next time. Linda followed her doctors advice and ate lightly when she first got home, but was able to resume her usual diet within days.
One month after surgery, Linda returned to her gym and began working slowly toward her usual routine, doing a few more repetitions each day and building back to her typical pace over the next few weeks. She enjoyed dinners at home and going out to eat, and before she knew it, life was back to normal. She stayed away from double helpings of ice cream and French fries, and realized she didnt miss her gallbladder at all.