Gallbladder Issues

[OldBroad]

My surgeon requires an ultrasound of the gallbladder and will leave it in if there is no evidence of pre-existing problems. He then prescribes that his patients who retain their gallbladders to take Ursiodol for a while after surgery.

My gallbladder passed the test, but then I started having some right-side discomfort about three weeks before surgery. The doctor poked around in my right side in my last pre-op visit and didn't find anything that concerned him. I asked if there was any point in starting the Ursiodol before surgery and he said, "I never thought of that. That's a good idea. Do you want to try it?"

So, he prescribed the medicine, 500 mg., twice a day. I was concerned about starting a new medicine, and since the pills were scored for halving, decided to try taking a half dose for a few days to see whether there were any side effects.

So, now I have no pain in my side, but I have diarrhea, which may have nothing to do with the medicine. My question to you all is, is there any point in trying to keep my gallbladder? Do any of you have experience with Ursiodol?

 

[bearmom]

I would ask him to PLEASE get rid of it as long as he is in there. My surgeon also was of the "if it aint broke, don't fix it" mindset, and all that did for me was keep that "good" gallbladder for a few years, then necessitate another surgery to remove it. My surgeon that took it out said that Actigall and urisiodal don't actually help.

 

[DianaCox]

After the DS, the gallbladder is pointless - your bile does NOT mix with your food in a bolus as it is released from the pyloric valve, and will end up trickling down the biliopancreatic limb anyway. It has no physiological purpose for a DSer.

I'm not fond of keeping useless organs, especially ones that can get cancer, infections, stones, and (in our case) can be a source of horrendous pain when they go bad, and which have to be ruled out in a differential diagnosis as a source of belly pain thereafter. I argued with Rabkin about whether it made sense to take out a perfectly healthy gallbladder, and he convinced me the answer is yes.

It's ursodiol, by the way - and it doesn't work very well (and causes diarrhea). http://en.wikipedia.org/wiki/Ursodeoxycholic_acid

My opinion: appendix and gallbladder OUT with the DS, while they're in there anyway. Then you never have to worry about gall stones or appendicitis ever again. One surgery, one recovery.


http://www.ncbi.nlm.nih.gov/pubmed/25589017

Obes Surg. 2015 Jan 15. [Epub ahead of print]
Incidence of Gallstone Formation and Cholecystectomy 10 Years After Bariatric Surgery.
Melmer A1, Sturm W, Kuhnert B, Engl-Prosch J, Ress C, Tschoner A, Laimer M, Laimer E, Biebl M, Pratschke J, Tilg H, Ebenbichler C.
Author information

Abstract
PURPOSE:
Rapid weight loss is a risk factor for gallstone formation, and postoperative treatment options for gallstone formation are still part of scientific discussion. No prospective studies monitored the incidence for gallstone formation and subsequent cholecystectomy after bariatric surgerylonger than 5 years. The aim of the study was to determine the incidence of gallstone formation and cholecystectomy in bariatric patients over 10 years.

MATERIALS AND METHODS:
One hundred nine patients were observed over 10 years after laparoscopic gastric banding or gastric bypass/gastric sleeve. The incidence of gallstone formation and cholecystectomy was correlated to longitudinal changes in anthropometric parameters.

RESULTS:
In total, 91 female and 18 male patients were examined. Nineteen patients had postoperative gallstone formation, and 12 female patients required cholecystectomy. The number needed to harm for gallstone formation was 7.1 and 2.3 cases in the banding group and gastric bypass/gastric sleeve group, respectively. The number needed to harm for cholecystectomy was 11.6 and 2.5 cases in the banding group and the gastric bypass/gastric sleeve group, respectively. Weight loss was higher in patients requiring subsequent cholecystectomy. Mean follow-up tocholecystectomy was 21.5 months with the latest operation after 51 months.

CONCLUSION:
Female gender and rapid weight loss were major risk factors for postoperative cholelithiasis. Ultrasound examinations within 2 to 5 years are recommended in every patient, independent of bariatric procedure. Pharmacologic treatment should be considered in high risk patients within 2 to 5 years to prevent postoperative cholelithiasis. This helps to optimize patient care and lowers postoperative morbidity.
​

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106056/pdf/JOBE2014-468203.pdf

J Obes. 2014;2014:468203. doi: 10.1155/2014/468203. Epub 2014 Jul 3.
Complicated gallstones after laparoscopic sleeve gastrectomy.
Sioka E1, Zacharoulis D1, Zachari E1, Papamargaritis D1, Pinaka O1, Katsogridaki G1, Tzovaras G1.
Author information

Abstract
BACKGROUND:
The natural history of gallstone formation after laparoscopic sleeve gastrectomy (LSG), the incidence of symptomatic gallstones, and timing of cholecystectomy are not well established.

METHODS:
A retrospective review of prospectively collected database of 150 patients that underwent LSG was reviewed.

RESULTS:
Preoperatively, gallbladder disease was identified in 32 of the patients (23.2%). Postoperatively, eight of 138 patients (5.8%) became symptomatic. Namely, three of 23 patients (13%) who had evident cholelithiasis preoperatively developed complicated cholelithiasis. From the cohort of patients without preoperative cholelithiasis, five of 106 patients (4.7%) experienced complicated gallstones after LSG. Total cumulative incidence of complicated gallstones was 4.7% (95% CI: 1.3-8.1%). The gallbladder disease-free survival rate was 92.2% at 2 years. No patient underwentcholecystectomy earlier than 9 months or later than 23 months indicating the post-LSG effect.

CONCLUSION:
A significant proportion of bariatric patients compared to the general population became symptomatic and soon developed complications after LSG, thus early cholecystectomy is warranted. Routine concomitant cholecystectomy could be considered because the proportion of patients who developed complications especially those with potentially significant morbidities is high and the time to develop complications is short and because of the real technical difficulties during subsequent cholecystectomy.
​

http://www.ncbi.nlm.nih.gov/pubmed/24462305

Surg Obes Relat Dis. 2014 Mar-Apr;10(2):313-21. doi: 10.1016/j.soard.2013.10.011. Epub 2013 Oct 25.
How frequently and when do patients undergo cholecystectomy after bariatric surgery?
Tsirline VB1, Keilani ZM2, El Djouzi S3, Phillips RC3, Kuwada TS3, Gersin K3, Simms C3, Stefanidis D4.
Author information

Abstract
BACKGROUND:
Rapid weight loss after bariatric surgery is associated with gallstone formation, and cholecystectomy is required in up to 15% of patients. Prophylactic cholecystectomy or prophylactic ursodiol administration in the postoperative period have been suggested to address this problem. The objectives of this study were to investigate the frequency and timing of cholecystectomies after bariatric surgery and to determine the associated risk factors in patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic adjustable gastric band (LAGB), or laparoscopic sleeve gastrectomy (LSG).

METHODS:
Data prospectively collected in an institutional database were analyzed. Differences among the 3 procedures and the effects of ursodiol administration, patient demographic characteristics, postoperative weight loss, and individual surgeon practices on cholecystectomy rates were examined. Survival analysis and proportional hazard models were used.

RESULTS:
Of 1398 patients, 109 (7.8%) underwent cholecystectomy with a median follow-up of 49 (range 12-103) months. Cholecystectomyfrequency was 10.6% after LRYGB, significantly higher than 2.9% after LAGB (P < .001), and 3.5% after LSG (P = .004). The frequency was highest within the first 6 months (3.7%), but declined over time to < 1% per year after 3 years. Ursodiol administration did not affect cholecystectomy rates (P = .97), and significant intersurgeon variability was noted. Excess weight loss (EWL)>25% within the first 3 months was the strongest predictor of postoperative cholecystectomy (P<.001). Cox hazards model revealed 1.25 odds ratio per 10% EWL within 3 months, and odds ratio .77 per decade of life. In addition, white patients had 1.45 times higher cholecystectomy rates than did black patients. Preoperative body mass index, gender, and surgeon did not affect cholecystectomy rates.

CONCLUSION:
Bariatric surgery is associated with a low frequency of postoperative cholecystectomy, which is highest early after surgery and mainly determined by the amount of EWL within the first 3 months. The results of the present study do not support routine prophylactic cholecystectomy at the time of bariatric surgery in asymptomatic patients.

​

 

[southernlady]

I WISH mine had been removed during my DS...it wasn't and 6 months later, I was in for another surgery.

 

[Larra]

What Diana said...and I will add to that that if you do develop gallstones later (as many people do with rapid massive weight loss regardless of how the weight is lost) and if one of those stones sneaks into your bile ducts, it can't be removed with the standard method of ERCP after either DS or gastric bypass. There are other methods for removal of a common bile duct stone, but they are more difficult, and if they fail you would need more done at the time of your gall bladder removal to get that stone out of the duct, and if it can't be done via laparoscopy you would need open surgery.
Hopefully it would never come to this, but you won't be happy if it does. I had my gall bladder removed during my DS and have never missed it. The gall bladder doesn't make anything, it's just a storage depot for bile. And as Diana said, once you have your DS, the bile just trickles into the bilio-pancreatic limb and doesn't mix with the bolus of food anyway. Removing it during your DS will add a little more time to your surgery but there is a good chance it will save you a whole nother operation down the line. That's my opinion, anyway, though I admit it's considered a controversial subject in the bariatric surgery community.