I hear this question a lot from my patients that are about to have obesity surgery.
My answer is a very authoritative, “I don’t know.”
Many of my bariatric surgery colleagues automatically include galbladder removal for all of their patients, others do not. However in a recent article, in the medical journal Helaptology – (Hepatology, volume 58, issue 6, pages 2133-2141) there is strong evidence to suggest that with every 1 increase in BMI there is a 7% increase in silent gallstone formation.
So then the obvious question is, “Dr Dirk, why not make gallbladder removal a routine part of all obesity operations?”. The not so scientific answer is that gallbladder surgery in an obese patient is not simple and can be a source of surgical problems. Obesity surgery is tough enough as it is. The last thing I want to do is make it tougher for my patients.
I have no problem surgically removing a gallbladder that has stones or sludge in it. Removing a gallbladder that is normal can pose problems, such as post-cholecystectomy diarrhea – which is Greek for – I get diarrhea every time I eat after having my gallbladder removed. While this sounds horrible, it is not, but it is an inconvenience. Post-cholecystectmoy diarrhea affects about 7% of patients who have their gallbladder removed for any reason. This tends to disappear after about 6 months, but for 1% of patients, this can be a lifelong thing.
The other important item is that, for some obesity surgery patients, it is almost physically impossible to remove the gallbaldder. Because obesity can increase the size of the liver and the gallbladder lives right beneath the liver, it can get dicey down there. I do not want to hurt any of my patients by doing an operation that can be delayed, when they are smaller and the operation can technically be easier.
Given this powerful scientific evidence, here is what I am going to do for all my future bariatric patients. I will do an ultrasound on their gallbladders. If it is negative, the gallbladder stays in place. If there is evidence of stones, sludge or thickening, I will talk to my patients about removing their gallbladder at the same time of surgery. However!!! If during surgery, I feel that it would be too dangerous to remove their gallbladder, I will delay it until they lose more weight and it is safer to do their gallbladder operation.
If you have questions or concerns about your gallbladder, call my office.