Should I have my gallbladder removed prophylactically?

[Clematis]

I'm in a quandary over whether to have the surgeon remove my gallbladder when he does the DS. (He will do it for $2000 upcharge.) Twice before about 8 months in to a rapid weight loss diet, I had episodes of horrible upper abdomen/back pain so I don't think my gallbladder will deal with post-surgery weight loss quietly.

Advice, please.

 

[Jo777]

From all I've read- do it. Doubly so if you've had pain that sounds suspiciously GB related.. better knock it out now, then risk having to go back in a few months later, not to mention from what I've heard- GB attacks really suck.

 

[Whit]

Do it. But so odd you are being charged extra for this. I mean the Doc is going to be in there anyway.

 

[DianaCox]

Your surgeon is being an asshole. Tell him you have been diagnosed with gall bladder attacks in the past, which are symptomatic of gallstones and/or sludge, and that he should take it out as part of the surgery. But I guess if it's self-pay, he can do that.

http://www.ncbi.nlm.nih.gov/pubmed/25804356

CONCLUSIONS:
Nearly 50 % of our patients had either experienced gallstones before LRYGB or developed gallstones after LRYGB. In the group with new gallstone development, 50 % required emergency cholecystectomy. These results, together with the reported better quality of life after a combined procedure and the reported economic benefits, support the use of concomitant prophylactic cholecystectomy in patients undergoing LRYGB.​

 

[Settledownnow]

YES. Do not base the decision on money - just do it.

 

[Clematis]

Thanks everyone.

The surgeon is Ungson's protege Esquerra in Mexicali. I don't know that he even knows about this quote. I sent an email to the coordinator late last night asking if I could have it removed and she immediately responded with $2k upcharge like she pulled it out of her ass. I thought it was very high considering the entire DS is only $11k. I suspect that $2k is their cost of a cholecystectomy performed on its own.

 

[Larra]

Yes, double check on the cost, but would it also be possible for you to have an ultrasound covered by insurance at home to see if you do or don't have gallstones and/or sludge in your gallbladder? If you do, you should get that thing out for sure.

 

[Clematis]

@Larra I don't know if I want to ask my PCP this. She is not at all on board with WLS for anyone, not just me.

What are the CONS to having the gallbladder removed?

 

[Larra]

@Clematis you don't have to frame your request in terms of bariatric surgery preparation. Just tell her about the symptoms you have had and that you are concerned that you could have gallstones. Gallstones are extremely common, and ultrasound is the best test to look for them, is not invasive and carries no risk.
the bottom line, though, is that I don't care what she thinks and neither should you. We are talking about medical care here, not a pedicure. You have every right to get a diagnostic procedure, if needed, so that you can make the best possible decisions for your medical care.

 

[Larra]

And I got so caught up in my antipathy for your pcp that I didn't answer your question. The only function the gall bladder has is to store bile. When you eat, the gall bladder contracts and squirts bile into the bile ducts, and from there it goes into the duodenum. So after the gall bladder is removed, the bile is still made in the liver just like always, and gradually trickles down the bile ducts instead of being stored in the gb.
But for someone who has had either DS or gastric bypass, the duodenum (well most of it with the DS) is bypassed so it doesn't matter whether you store bile in the GB or not. So the only real disadvantage to having it removed is some added surgical risk and a little extra time under anesthesia.
On the other hand, if you keep a diseased GB, you are at risk for the GB to become inflamed in the future, or for GB "attacks" from stones, which can be very painful, or from a stone getting stuck in the bile ducts. And if you don't have gallstones already, the rapid weight loss puts you at increased for developing them.
I've tried to be even handed here but you have probably figured out by now that I do have a point of view.

 

[Clematis]

@Larra I prefer people with points of view so keep it comin'

I'm definitely leaning towards just having the thing out.

The surgery coordinator says adding GB removal is another 30 minutes. I've researched this doctor's competence as a DS surgeon but have zero data on his skill at gallbladder removal. Is lap GB removal a rather straightforward procedure? Do I have cause for concern if he hasn't removed a lot?

 

[Larra]

Gall bladder removal is a very common operation in the USA and while I don't know the statistics, I would guess that it's also very common in Mexico because Hispanic and Native American people are among the peoples most prone to gallstones in the world. It is a much easier operation than the DS and Dr. Esquerra probably did hundreds of gall bladder removals before he ever did a DS. But of course you can, and should, ask about that.

 

[Munchkin]

Do it! Almost everyone who is heavy will have GB issues sooner or later! I insisted mine be removed and after the surgery the doc said I was right!

Plus over the years I have seen quite a few people keep theirs and even take actigall postop only to end up with another surgery in 6 months or a year.

 

[southernlady]

Plus over the years I have seen quite a few people keep theirs and even take actigall postop only to end up with another surgery in 6 months or a year.

Yes, me altho I wasn't given the actigall. Mine came out almost exactly 6 months after my DS. Turns out it was headed south long before my DS but didn't give me pains until after.

 

[duh_Mom]

@Clematis - when in doubt whack it out. if you are already having GB issues and it sounds as if you are - then get rid of it. I had mine out years before my DS - not for stones, but the sucker had quit working. I had periodic bouts of nausea and vomiting that I alway related to the 'stomach flu'. the episodes got worse over the years before I finally asked for a hida scan and wha la - it was broke.

if you are prone to that kind of issue any way - you will want it out. Otherwise, you will be wondering if any nausea etc you are having post op is due to the GB. It would be extra 'noise' post op if any issues arise.

Like, I said - when in doubt whack it out.