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Gallbladder Health PDF Print E-mail

"Pain persists in many patients five years after removal of the gallbladder" reports a study referenced below." IS GALLBLADDER REMOVAL REALLY NECESSARY? Over 1/2 million people in America have their gallbladders removed every year. Is it necessary? Not that often it isn't. Sometimes it is absolutely necessary, but not always. How do you know for sure?

That's not easy to determine. Most doctors advise gallbladder removal with any diagnosis of a gallbladder problem. Large gallstones, small gallstones, low-functioning gallbladder, few symptoms, no symptoms. If the diagnosis warrants surgery, you are advised to take it out. But the same diagnosis in thousands of people does not mean the same condition exists. For example, gallstones can be silent which means you are unaware of any problem going on. There are no symptoms at all and the gallstones are found by routine lab tests done for a separate issue. You may eventually develop symptoms or you could live a long life and never experience symptoms of gallstones. Or you may be one of those people who have frequent attacks and on-going pain who just can't live with it.

The majority of people we hear from here at Gallbladder Attack are in the middle. They had an attack; it's behind them now, but they still have discomfort that gets worse when they are under stress or when they eat the wrong foods. If you are in that camp, you have a choice to make. Part of that choice involves whether or not you are willing to make both lifestyle and dietary changes. If you do opt for gallbladder removal, will your digestion be perfect afterwards? That's what everybody's hoping for, to be pain free, gas free, bloat-free and to be able to eat whatever they like. You have a 60% chance of that happening. Out of every 10 cholecystectomies, 4 people will still have symptoms. Those symptoms are rarely, if ever, equal to that of the previous gallbladder attack. They are more often discomfort, or dull pain. But you need to be aware. So read the research and find out what your chances are of that happening before you give your body parts up.

The most frequently asked question I am asked from people who have had surgery is this: "Why is that that I still have pain even though my gallbladder has been removed?" If you think of your problem as a biliary (bile) problem as opposed to a "gallbladder" problem you are more on the right track to understanding how to take care of it. Removing the gallbladder does not always address the problem in the body that is causing these symptoms. In order to break down and digest fats, your body must produce bile, which is done in the liver. Your gallbladder is merely a sac for holding some of the bile that the liver produces. Whether or not you have had your gallbladder removed, your liver is still producing bile in order to digest fats. Without the gallbladder, however, the bile is not as readily secreted in the body, and the liver can become overwhelmed when faced with large amounts of carbohydrates and refined sugars. The gallbladder does facilitate and regulate the flow of bile in your body. When that facilitator is taken away it is quite possible that the flow will be not as efficient, ie. too much at one time or not enough.

The usual medical belief today is that fatty food can result in gall stones and thus the advice is to eat low fat. This rarely makes the disease go away. Instead it often gets worse with time. If you eat low fat, less bile is needed to digest your food and more bile stays in the gall bladder, long enough for stones to form. It’s been shown that people who eat more carbohydrates are at increased risk of gallstones!

Side Effects of Gallbladder Removal

One of the side effects of gallbladder removal can be the dumping of bile which is now not as easily regulated and can send someone running to the bathroom immediately after eating or even 3 hours or more after eating. A more common side effect is a decrease in the secretion of bile. If the bile produced by the liver becomes thick and sluggish, painful symptoms and bile stones can occur. Bile stones can form in the liver as well as the gallbladder. However, removing the gallbladder may be an absolute medical necessity but, unless it is diseased, ruptured or otherwise sick, know that just having cholelithiasis or gallbladder stones does not mean you have to take it out!

If you have gallbladder attacks, pain or discomfort or digestive problems but not a diseased gallbladder, this does not mean you necessarily have to have gallbladder surgery. Get a second opinion.

The most common problems, apart from actual pain are impaired digestion: bloating, gas, heartburn, constipation, vomiting or diarrhea. You are/were already having trouble with your gallbaldder so why would removing the organ that regulates the metabolizer of fats improve your digestion? It may help with the pain, but know that 34% of people who have their gallbladder removed still experience some abdominal pain. (4)

CAN I FUNCTION WITHOUT A GALLBLADDER?

Yes you can. The bile will still be produced in the liver and find its way to the small intestine. It will continue to break down your dietary fats and to remove toxins from the liver. What is different is that the bile will no longer be as concentrated (the gallbladder removes 90% of the water from the bile) and its function as a regulator will be gone. Some people have no problem with this at all; others have problems with getting the right amount of bile at the right time, either too much or too little.

IS GALLBLADDER SURGERY EFFECTIVE?

What is meant by effective? Will you never have another gallbladder attack? I mean, how could you if you have no gallbladder, right? Will you never suffer from indigestion again? Will your gas and bloating disappear? Will the constipation go away? Will diarrhoea resolve? The answer to all of the above is "sometimes". Actual attacks are rare, but other forms of pain and discomfort are possible and new symptoms can also develop.

Read on... Let's look at gallbladder attacks. Gallstones can also be found in the liver and the bile ducts leading to the gallbladder. The attack is often (but not always) caused by a stone blocking a duct. And yes, this can still happen. As seen by research above, stones are formed partly due to what we eat. If we take the gallbladder out and continue to eat the same diet that we did before, why should stones not form? They will. You may never know it. You may be asymptomatic for the rest of your life. Or, you may get a stone stuck in a bile duct. This is one of the reasons for the most frequently asked question on this site: "I had my gallbladder removed months (or years) ago. Why do I still have pain?" Removing the gallbladder does not always address the problem in the body that is causing these or other symptoms listed above. It has probably taken years for your body to form these stones. Your digestion has been impaired for a long time. To address the root of the problem you must study and reflect on the causes of gallbladder disease. There could be an underlying thyroid problem which research connects with both gallstones and a low-functioning gallbladder. Food allergies may also be a big part of it and stress as well.

POSSIBLE SIDE EFFECTS FROM GALLBLADDER REMOVAL LIFE AFTER GALLBLADDER SURGERY Abdominal pain, nausea, gas, bloating, and diarrhoea are common following surgery. Postcholecystectomy syndrome (after gallbladder removal syndrome) may include all of the above symptoms plus indigestion, nausea, vomiting and constant pain in the upper right abdomen. Sound familiar? You're right -- gallbladder attack symptoms.

Up to 40% of people who undergo gallbladder surgery will experience these symptoms for months or years after surgery.(7) How is this possible? You no longer have a gallbladder and that was the problem, right? Look to the whole biliary tract. Now that the gallbladder is no longer present to act as a reservoir for bile, the common bile duct may expand as the bile backs up in the bile duct between the sphincter or muscular opening at the small intestine and the liver from which it flows. If it drips constantly into the small intestine this can cause problems of a different kind. However, this syndrome with accompanying pain appears to have the flow of bile obstructed by either a narrowing of the sphincter or a malfunction of the sphincter.(1) "Functional biliary pain in the absence of gallstone disease is a definite entity and a challenge for clinicians." which is to say that at this point in time, they don't really know what to do with gallbladder problems that aren't related to gallstones (2) and "Often, following cholecystectomy, biliary pain does not resolve..." (2) which means after gallbladder surgery you may just be stuck with the pain.

So in conclusion, your best bet may be to try and fix what is wrong if that is possible, before taking it out. Sometimes, that is just not possible.

WEIGHT GAIN AFTER GALLBLADDER SURGERY

We often get the question, "Why did I gain weight after having my gallbladder removed?" First of all, even though the liver continues to make bile, the gallbladder concentrates it, making it more effective and it also controls the rate at which it is released, giving larger amounts when needed. Without a gallbladder, that is no longer happening. So for many people, their fat metabolism is not nearly as efficient as it should be. (It could be better than it was, depending on the reasons for removal.) Truthfully, people with any gallbladder disease may have trouble with weight gain due to faulty fat digestion. However, other factors are likely involved simultaneously. Just take a look at the underlying causes of gallbladder disease. Many of these, in and of themselves, also cause weight gain. Low thyroid, insulin resistance, heartburn and indigestion, acid reflux.

Until they are addressed, you may find maintaining a normal weight more and more difficult as time goes on.

(1)Torsoli A, Corazziari E, Habib FI, Cicala M. Scand J Gastroenterol Suppl. 1990;175:52-7 Pressure relationships within the human bile tract. Normal and abnormal physiology.

(2) Shaffer E., Dig Liver Dis. 2003 Jul;35 Suppl 3:S20-5

(3) Surgical Endoscopy Publisher: Springer New York ISSN: 0930-2794 (Paper) 1432-2218 (Online) DOI: 10.1007/BF00188454Issue: Volume 9, Number 9 Date: September 1995 Pages: 977 - 980

(4) Bates T; Ebbs SR; Harrison M; A'Hern RP.Influence of cholecystectomy on symptoms. Br J Surg. 78(8):964-7, 1991 Aug.

(5) E Ros, D Zambon Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years after surgery. 1987 BMJ Publishing Group Ltd & British Society of Gastroenterology

(6) S Hearing, L Thomas, K Heaton, L Hunt Post-cholecystectomy diarrhoea: a running commentary Copyright © 1999 BMJ Publishing Group Ltd & British Society of Gastroenterology.

(7) CAROLE MACARON, MD,MOHAMMED A. QADEER, MD, MPH, JOHN J. VARGO, MD, MPH, Cleveland Clinic Journal of Medicine March 2011 vol. 78 3 171-178, Recurrent abdominal pain after laparoscopic cholecystectomyVetrhus M,

(8) Pain persists in many patients five years after removal of the gallbladder: observations from two randomized controlled trials of symptomatic, noncomplicated gallstone disease and acute cholecystitis., Berhane T, Søreide O, Søndenaa K, J Gastrointest Surg. 2005 Jul-Aug;

9(6):826-31.