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Gallbladder Surgery

"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 GallbladderAttack 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 symtpoms. 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. And scroll over to the right of this page to read what my readers are saying about their experiences. And if you've had a good experience and are symptom-free 2 and 3 years after surgery, please write and tell us about it. We want to hear from you too. I say 2 or 3 years because it sometimes happens that uncomfortable symptoms resolve after a year or so.

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 any fats, especially saturated fats and hydrogenated fats. And for some people even small amounts of fats can cause discomfort.
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 more commonly, not enough.

Whether you choose gallbladder surgery or not, consider taking products and changing your diet as well as doing a series of gallbladder and liver flushes to take care of the root of your gallbladder problem.
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. 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. One woman had her gallbladder removed only to end up back in surgery again two or three days later where they found stones in the bile ducts of the liver causing her alot of pain.

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.
You do have an option of cleaning up your diet, doing some work on your gallbladder and liver and keeping your organ of fat digestion. If you happen to think that nature made a mistake and that you don't need it anyway, you probably wouldn't be reading this page in the first place.

What's the worst thing that can happen? You try to clean up your act - spend time eating healthy and detoxing the bile and liver and...the gallbladder still needs to come out!



The most common problems, apart from actual pain are impaired digestion: bloating, gas, heartburn, constipation or diarrhea. You are/were already having trouble digesting fats. 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)

The easiest way to avoid this is to take a supplement of bile salts or choline with meals to help your body with the digestion of fats or to take our Herbal Digestive Bitters before or after each meal. And do a series of gallbladder flushes. Flushes are especially helpful after gallbladder removal to help flush out the bile ducts.
Supplemental bile salts, (unless you are experriencing bile dumping) available separately or in the After Gallbladder Removal Kit, should be taken frequently along with the digestive stimulant Bitters to help stimulate your own digestive juices. Alternating the dosage of bile salts will help to mimic the body's way of secreting bile. For example, take one with breakfast, two at lunch, three at dinner, two with breakfast the next day, and so on in rotation.

If you have the less common, but not unusual side effect after gallbladder removal of needing to run to the bathroom immediately after eating, you are probably getting too much bile instead of too little. This, unfortunately is much harder to control. Clay is sometimes helpful as are some medications that bind up the bile. Read more about postcholecystectomy diarrhea towards the bottom of this page.



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 diarrhea 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 lithogenic forming 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?" (See testimonials for examples.) 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 fat digestion has been impaired for a long time. In order to break down and digest fats, your body must produce bile, which is done in the liver. 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.


Another thing to keep in mind is that you could have another gallbladder disease that has not yet been diagnosed. For example, if an ultrasound is done and gallstones found, a cholecystectomy or gallbladder removal will be recommended without doing any further exploration. This is because the most obvious and easily diagnosed cause of gallbladder attacks is gallstones or cholelithiasis. And ultrasound is quick and non-invasive. However, if your gallbladder is ejecting bile below 33%-40% which is considered normal range, you would be diagnosed with a low-functioning gallbladder or biliary dyskinesia. This can only be determined with a HIDA scan which is an invasive procedure using radioactive dye. Symptoms of biliary dyskinesia are not always resolved with cholecystectomy either for various known and unknown reasons. One reason is that the problem could be with the Sphincter of Oddi rather than the gallbladder itself.

DIET AFTER GALLBLADDER SURGERY

If you understand that co-existant with your gallbladder disease is usually a problem of stagnant bile, cholestasis, or some imbalance in the bile composition itself, you will realize that most people are not out of the woods after surgery or able to eat anything they like. Treat your lack of a gallbladder as you would any gallbladder disease and eat the same way. Exactly what that means depends upon your symptoms. Some people have surgery having had few symptoms and others were in bad shape. If you are in the latter category, and are now still having some discomfort, you may be most comfortable giving your gallbladder a rest by following the strict 30-60 Day Gallbladder Menu Plan. Most people after surgery will be able to start with the 2nd Menu Plan which is more relaxed. Others will be comfortable just following the Gallbladder Foods Guidelines in the Helpful and To Be Avoided lists.


There is a whole page on gallbladder diet with foods that are good for the gallbladder (think "bile") and liver and foods that are hard on the biliary system. You still have a biliary system. Treat it gently and feed it nourishing foods. Of particular importance is the understanding of good fats and harmful fats. Follow the links on gallbladder diet for more information on both of these.

When should the gallbladder be removed?

Many doctors recommend gallbladder removal if you have had only one attack. Others will do so if you have repeated attacks. Some will do so if you have stones; others will say unless you are having attacks with the stones you can leave it. This is a place to get a second opinion and above all, to educate yourself; read all you can.

If your doctor finds that you have an infected gallbladder it will almost certainly have to come out. If it bursts you are in similar danger as with a burst appendix. Infection is then lose in the peritoneal cavity. This is like an explosion of infection from a place of contaiment to the body at large and is difficult to clean up.

If you have a motility problem or a problem with gallbladder contraction or low-functioning (see biliary dyskinesia under gallbladder diseases) gallbladder surgery is also recommended. Yet some doctors do not recommend gallbladder removal for biliary dyskinesia.

Complications of surgery

Apart from complications of surgery such as damage to the common bile duct with laparoscopic surgery (due to lack of visibility) or infection from an incision, one may develop postcholecystectomy syndrome. (See below.)

"During laparoscopic cholecystectomy, gallbladder perforation with leakage of bile and/or gallstones into the abdominal cavity occurs frequently." or 33% according to this study. However, there were no complications of infection or blockages in any of the subjects.(3)


POSSIBLE SIDE EFFECTS FROM GALLBLADDER REMOVAL

LIFE AFTER GALLBLADDER SURGERY

Abdominal pain, nausea, gas, bloating, and diarrhea 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 effecient 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.
Postcholecystectomy Diarrhea or Bile Dumping Syndrome

The uncomfortable and inconvenient side effect that some people experience following the removal of their gallbladder is that of running to the bathroom immediately or soon after eating. For some it is rather explosive. Whatever its presentation, it is an increased transit time which means that absorption of nutrients is impaired. Not a good situation for your overall health. You may find help from the Dumping Syndrome Kit on this site. It helps to bind the bile salts that accumulate in the intestine along with extra fluid. However, this quote from a British medical journal suggests that perhaps IBS is part of the problem and may have been there, if somewhat less problematic, before the surgery. If that is the case, try our Dumping Syndrome Kit, by all means. It can be helpful for all sorts of etiologies. But you may also want to read up on IBS and try some products specifically for an irritable bowel condition. I like the products at www.diverticulitisinfo.com.

"13-40% of patients have persisting abdominal pain after cholecystectomy although the vast majority regard their operation as a success. Up to 12% of post-cholecystectomy patients when questioned feel that they have diarrhoea as a consequence of their operation, and at least 4-5% of patients have a definite deterioration in their perceived diarrhoea or perceive that they have developed diarrhoea for the first time. Objective assessments postoperatively, however, rarely demonstrate new onset diarrhoea. Some of these patients may have the irritable bowel syndrome."6

IS THERE SOMETHING I COULD DO FOLLOWING GALLBLADDER REMOVAL THAT WOULD BE HELPFUL

Of course! Always keep following a clean, sensible gallbladder diet that includes good fats, lots of organic fruits and vegetables and lean meats and fish. And for at least 2 or 3 months immediately afterwards, follow the diet religiously and if you haven't done a Gallbladder Starter Kit, do so now to give your digestion and your fat metabolism a kit start. I also suggest a series of coffee enemas about a month after surgery (even years after if it's been that long) to flush all the bile ducts including those of the liver. Your biliary tree can benefit from this at any time as can your liver. I suggest one per day, if possible, for 21 days.

Then order the After Gallbladder Removal Kit and stay on it from now on. You will need the assistance in digestion that it offers, especially for digesting fats. That is the ideal. If it is beyond your means to do this, at least use bile salts with every meal.

(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.