The Surprising Connection Between Bariatric Surgery and Gallbladder Disease
By Douglas Olsen, MD
It is not uncommon for people to have gallbladder problems after bariatric surgery. In fact, studies show that about 30% of bariatric surgery patients develop gallstones after surgery, and 10% have problems serious enough to require removal of the gallbladder.
To understand the relationship between weight loss surgery and gallbladder disease, the function of the gallbladder has to be explored. The gallbladder stores bile that is made in the liver and is necessary for the digestion of fat. Without bile, the body cannot digest and absorb fat. The liver makes a continuous supply of bile, excreting it into the intestine just below the stomach, where the stomach empties into the intestine.
The gallbladder is a little "sac" that is connected to the main bile duct and collects bile and stores it for use during the digestion of large meals. When we eat a meal that is rich in fats, the body signals the gallbladder to empty it's bile into the bile duct to drain into the intestine where it will help maximize the digestion and absorption of the fat in the meal we just ate. During times of prolonged fasting or dieting, the stimulation of the gallbladder does not occur. As a result, the bile in the gallbladder becomes concentrated, which can result in the formation of gallstones as they "crystallize" out of the concentrated solution. It is the formation of these stones that causes symptomatic gallbladder disease.
After someone undergoes Bariatric surgery, the lack of significant caloric intake and, more importantly, the lack of any significant fat in the post op diet causes a marked absence of gallbladder stimulation. This deficiency of stimulation results in gallbladder stasis and a higher than normal risk of gallstone formation. This increased risk is seen within the first year, and it can be as high as 20-25% among patients who have undergone bariatric surgery. It is this increased risk in gallbladder disease that was historically the basis for the recommendation to routinely remove the gallbladder during weight loss surgery.
This recommendation was somewhat understandable when open surgery was the only option. However, indications to routinely remove the gallbladder have been re-evaluated in the era of laparoscopic surgery. To remove every bariatric patient’s gallbladder would incur needless risk in at least 75% of all patients, since there would be additional risk associated with removing the gallbladder itself.
Today, with laparoscopic surgery, it is safer to wait for those 20-25% of patients who are going to develop gallbladder problems and then remove the gallbladder than to routinely remove everyone's gallbladder. As the saying goes, "If it ain't broke, don't fix it".