The intended goal in removing the gallbladder is to remove the source of discomfort and if applicable, the source of infection. So, the first order of business to discuss is, “Does gallbladder surgery always remove the source of the pain?”

There is no doubt that gallbladder attacks are completely gone, at least so far as the gallbladder is involved. However, there can still be gallstone attacks due to stones in the bile ducts, called choledocholithiasis, which can still continue to form after removal.

Surgical complications can happen, such as nicking a bile duct causing bile leakage, injury to the intestines which are very nearby, infections, and thrombosis.

The following side effects of gallbladder removal are ongoing and primarily a result of the gallbladder being gone.

Possible Side Effects of Gallbladder Removal

• SOD or sphincter of Oddi dysfunction
• Dumping syndrome
• Bile reflux
• Barrett’s esophagus
• Pancreatitis
• Increased incidence of colon cancer years down the road
• Increased digestive symptoms such as heartburn
• Constipation
• Toxic bile
• Leaky gut
• Weight gain

Constipation and/or dumping are a result of losing your bile system regulator – one of the jobs of the gallbladder. Since the role of storing and concentrating bile has been removed, the bile that is delivered for digestion is often a lesser amount than needed and not as strong as usual resulting in impaired emulsification of fats. Then the fat-soluble vitamins are not metabolized which results in its own set of symptoms.

The opposite problem also occurs wherein too much bile dumps all at once, causing dumping syndrome and running to the bathroom after eating. Since the food goes through so quickly, this can end up in malnutrition. Pancreatitis can be due to gallstone or sludge blocking the pancreatic duct causing a backup of pancreatic juices into the pancreas.

Sphincter of Oddi Dysfunction (SOD) has other mechanical underlying problems, one theory being increased tonicity of the muscles and/or issues with hormone control of the sphincter muscles.

However, the increased inflammation caused by toxic bile could cause hyper or hypotonicity of these muscles as well as increased pressure. So SOD likely has a connection to the inflammation caused by toxic bile as do all the other symptoms listed.

Toxic bile is a condition that has already started with any impairment of the gallbladder and biliary ducts. However, it gets worse after surgery and is responsible for many of the side effects after gallbladder removal that occur either soon after or years down the road.

The bile acids are usually in homeostasis, that is, they are in balance with each other – fat-soluble and water-soluble. As the disease progresses, the fat-soluble bile acids, which are more toxic and inflammation-producing, begin to outnumber the water-soluble acids.

This makes the mixture of bile that is flowing more caustic to the surrounding tissues. Cox-2-type inflammation is found to be present within the bile ducts with this condition.

Inflammation has its own cascade of events:

• affecting sphincters so that they do not close as tightly, allowing back up in all directions
• bile reflux
• acid reflux
• Barrett’s esophagus
• Pancreatitis
• Sphincter of Oddi Disorder
• Heartburn
• Colon cancer

95% of bile acids are recycled back to the liver. The other 5% continue on down the intestines and out with the stool. The toxicity of this bile leaves inflammation in its wake, one result being, an increased incidence of colon cancer years later.

Most symptoms after gallbladder removal are a result of or related to these side effects.