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Signs You May Need Your Gallbladder Removed
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Signs You May Need Your Gallbladder Removed

By David Okolica, MD FACS FASMBS

 

Jane is one of my bariatric patients. She came to me two years ago with huge pressure beneath her breastbone that persisted for weeks and wouldn’t go away. She tried deep breathing, shifting positions in bed and even light exercise to help relieve her discomfort. But she still felt someone was shoving a fist in her chest. She couldn’t eat or sleep very well without pain. She came to me for a follow up visit and described her condition. After examining her I began to suspect it was a gallstone. Later, after further tests, it was determined that I was right.

 

There are many bariatric patients who have gallbladder disease that can present challenges to the patient as they progress through the bariatric program, either before or after bariatric surgery. Bariatric patients should be aware of common signs and symptoms of gallbladder disease and bring them to the attention of the bariatric surgeon in a timely manner so testing and treatment can be initiated for this diagnosis.

 

Gallbladder disease is commonly seen in the general population, but it is even more prevalent within the bariatric population, as obesity predisposes the bariatric patient to develop this disease at a higher rate due to metabolic disease. Gallstones may form in the gallbladder, usually due to precipitation of cholesterol within the bile, as cholesterol levels are generally higher in the obese population. After bariatric surgery, bariatric patients are also more likely to develop gallbladder disease as they are eating fewer calories and the gallbladder is not being stimulated, which leads to poor contractility of the gallbladder and poor bile flow. For some bariatric patients, they already have had the gallbladder surgically removed, which makes developing symptoms of gallbladder disease extremely unlikely.

 

For the majority of patients who have not had the gallbladder surgically removed, typical signs and symptoms of gallbladder disease include intermittent upper abdominal pain on the right side after eating, particularly with fried or greasy foods, but sometimes, with any type of meal. Pain is usually associated with nausea or vomiting, heartburn or acid reflux disease, and bloating or changes in bowel habits. While there are many other digestive diseases that can cause similar symptoms, gallbladder disease is very common in the bariatric patient, and it should be tested for by the bariatric surgeon soon after symptoms develop. Imaging tests can be performed to check the gallbladder for gallstones and measure the contractility of the gallbladder in a non-invasive and accurate way. Gallbladder disease may also be discovered in patients who do not have any abdominal pain, such as long-standing diabetic patients, who undergo bariatric surgery and gallbladder disease is noted while looking inside the abdomen to perform the bariatric procedure.

 

Patients should understand that if digestive symptoms or abdominal pain develop while in the bariatric program, they should let the bariatric surgeon know.  It is better to discover gallbladder disease early and treat it promptly, as opposed to waiting until the patient ends up in the emergency room with a painful gallbladder attack. This situation is more dangerous to the patient, as the patient quickly becomes sicker, and gallbladder surgery is more difficult to do from a technical perspective. Once chronic gallbladder disease develops, it is unlikely to resolve on its own, and medical therapy is ineffective to provide long-term relief. Therefore, laparoscopic surgery to remove the gallbladder is the standard treatment for gallbladder disease, which removes the gallbladder with any gallstones within, and provides long-term symptomatic relief from gallbladder disease.