Reasons to Avoid Getting Gallbladder Removed

The Gallbladder — A Small Pear Shaped Organ

The gallbladder is a small pear shaped organ located near the lower border of the liver. The bile which is secreted by the liver and which is essential for the digestion of fat in the small intestine is stored in the gallbladder.

Gallbladder disease includes stone formation and infection. In many instances, the gallbladder has to be removed surgically to prevent complications. Removal of the gallbladder can lead to various complications and is hence avoided whenever possible. The various reasons to avoid getting the gallbladder removed include the development of diarrhea after the operation, and potental injury of the bile duct during surgery, which may cause obstruction to the flow of bile. [1]
 

Gallbladder, Liver And Bile

The liver is the largest organ in the body, aside from the skin. It performs multiple functions like synthesis, excretion, detoxification and storage. The liver is connected to the small intestine with bile ducts, through which bile flows from the liver to the intestine. At the lower border of the liver, the pear shaped gallbladder is present. This organ is attached to the bile duct by means of the cystic duct. It stores and concentrates bile, a green to brown liquid that helps your body digest fats. [1]

When a person is not taking food, the bile from the liver flows into the gallbladder and gets stored and concentrated there. When a person eats, especially a fatty meal, the gallbladder contracts and the bile from it flows into the small intestine where it helps in the digestion of fat. After assisting fat digestion, the bile gets reabsorbed at the terminal portion of the small intestine and reaches the liver, from where it is secreted again. A small quantity of bile is lost in the stools. The gallbladder is not a vital organ, as it performs the function of only storing bile and hence a person can live without a gallbladder.

Diseases Of The Gallbladder

Though the gallbladder is not a vital organ, it can be subject to a number of diseases, some of which can result in serious complications. Gallbladder disease can occur in both sexes though it is more common in women. The two most common diseases involving the gallbladder are gallstone disease and cholecystitis.

In gallstone disease, stones are formed in the gallbladder. These gallbladder stones usually do not cause any symptoms. But sometimes gallbladder stones do cause symptoms, and they can also lead to serious complications when they obstruct the flow of bile from the gallbladder by blocking the cystic duct or by moving into the bile duct and causing obstruction.

The symptoms of gallbladder stones can include abdominal pain, fever, and jaundice, a yellowing of the eyes and skin. The process of gallstone formation is generally a slow process, and usually causes no pain or other symptoms. Gallstones can range in size from a few millimeters to several centimeters in diameter. About 70% of gallstones are formed from cholesterol, and about the remaining 30% of stones are pigment stones (black or brown). Patients can have a mixture of the two gallstone types. About three-fourths of the gallstones found in the US population are formed from cholesterol. [2]

In cholecystitis, the gallbladder is inflamed. This inflamation can be due to gallstone disease and can occur in conditions other than gallstone disease also when it is called acalculous cholecystitis. The symptoms include sharp, cramping, or dull pain, steady pain or pain that spreads to your back or below your right shoulder blade. Other symptoms may include fever, clay-colored stools, nausea and vomiting, yellowing of skin and whites of the eyes (jaundice). The main symptom is a pain in the upper right side or upper middle of your belly that usually lasts at least 30 minutes. [3]

Removal Of The Gallbladder

Gallbladder removal is medically called cholecystectomy. It can be done laparoscopically or by using the more traditional open method (by opening the abdomen). Gallbladder removal surgery is usually performed if a person suffers from cholecystitis or is having painful gallstone disease. There are other less common indications as well. Approximately 700,000 cholecystectomies are performed for gallstone disease in the United States each year. Most of these are laparoscopic cholecystectomies. 

Reasons To Avoid Gallbladder Removal

There are many reasons to avoid having your gallbladder removed. They include potential complications arising during surgery and complications due to the absence of the gallbladder. The following are some of the reasons to avoid having your gallbladder removed.

Complications During Cholecystectomy

Cholecystectomy can be done both using an open surgical method and a laparoscopic method. Complications are more likely to occur when using the open method. The complications during surgery include [1]:

• Bile leak
• Injury to bile duct
• Pancreatitis

Of these, injury to bile duct is most important and the most serious. The rate of bile duct injury is one in every 200 to 600 gallbladder removal cases. When the bile duct gets injured, it heals over a period of time with some amount of narrowing of the duct as a result of scar tissue formation. When the bile duct becomes narrowed, it obstructs the flow of bile from the liver. This could lead to fever, abdominal pain, and jaundice. When there is a complete obstruction, it affects fat digestion and absorption of fat-soluble vitamins like vitamin A, D, E and K. When vitamin K is not absorbed, it could lead to bleeding from various sites. When the obstruction is not relieved at the appropriate time, it can in turn affect the liver causing secondary biliary cirrhosis. A bile duct injury can be treated endoscopically and surgical treatment is rarely needed. [4]

A bile leak can lead to bile peritonitis with symptoms like a fever in the postoperative period, severe abdominal pain and vomiting. Bile peritonitis needs surgical treatment. Pancreatitis causes severe abdominal pain that may radiate to the back. Pancreatitis can be treated medically.

Patients can reduce their risk of complications following cholecystectomy by strictly following their surgeon's postoperative instructions. During the immediate post gallbladder removal recovery period, it is important to allow your body to recuperate. Reintroduce varied food items gradually over a period of time, utilize painkillers as needed in agreement with your treating surgeon, and remember that depending on the mode of surgery, it will take between two and six weeks to be able to resume your normal daily activities. 

Complications Due To Absence Of The Gallbladder

As previously mentioned, the gallbladder performs the function of storing and concentrating bile. It releases bile in to the small intestine in an orderly manner in response to food intake. When the gallbladder is removed, this function is lost. The bile from the liver enters the small intestine directly. There is no control mechanism to regulate this flow of bile, so it will flow continuously after a gallbladder removal surgery.

Some amount of bile stays in the upper small intestine until it is "called on" to become involved in the digestion of fat after the consumption of a fatty meal. Since there is no regulation of bile flow, most of it flows to the terminal part of the small intestine from where it is absorbed. But because of the overload not all of it is absorbed. The bile that is not absorbed reaches the colon, causing diarrhea. Diarrhea is one of the most commonly reported complications of removal of the gallbladder. It often subsides over a period of time. But in some individuals, the diarrhea may persist for a longer time, which affects the patient's quality of life and causes a risk of dehydration. [2]

There are a few controversial studies which state that persons who undergo gallbladder removal can develop cancer of the right colon later. The studies showed that after a period of about 10 years signs of cancer appear on the right colon. They attributed this to the presence of the bile acids some of which are toxic, which escape absorption in the terminal small intestine. But there are other studies which have found no such association, so it remains a controversial issue.

Something that is clear, is that up to 30% of gallbladder removal patients continue to suffer from diarrhea, and many also experience abdominal discomfort. Patients who have undergone a cholecystectomy will be advised to remain adherent to a special diet only in the first few weeks following their surgery. However, they can avoid diarrhea and discomfort adhering to a low-fat, high-fiber diet after gallbladder removal taken in smaller portions more frequently. It is also prudent to eliminate spicy foods from the diet after gallbladder removal. 

READ What your doctor forgot to tell you about gallbladder removal

Postcholecystectomy Syndrome

Postcholecystectomy Syndrome refers to the occurrence of symptoms after the removal of the gallbladder (cholecystectomy). It is seen in as many as 5 to 40% of those patients who have their gallbladder removed. The symptoms of Postcholecystectomy Syndrome include abdominal pain, upper abdominal discomfort, flatulence and abdominal bloating.

Most often it is due to stones present in the bile duct which were not taken care of during the removal of the gallbladder. Postcholecystectomy Syndrome can occurs in the post-operative period and it can also manifest much later — some people develop symmptoms months or years after their gallbladder removal. 

Postcholecystectomy Syndrome is not a completely accurate term because it includes a large number of disorders, both biliary and extra-biliary in origin, that may be unrelated to cholecystectomy. Up to 50% of Postcholecystectomy Syndrome patients suffer from organic pancreaticobiliary and/or gastrointestinal disorders, whereas the remaining patients are affected by psychosomatic or extra-intestinal diseases. Moreover, in 5% of patients who undergo laparoscopic cholecystectomy, the reason for chronic abdominal pain remains unknown. [6]

All the above-mentioned factors are to be taken into consideration while planning the removal of your gallbladder. Though these are some of the reasons to avoid gallbladder removal, one should remember that gallbladder removal should be avoided only when there is no clear indication for it, as in asymptomatic gallstones. But the removal of the gallbladder should not be avoided when the person gets repeated attacks of pain due to gallstone disease and in case of severe inflammation of the gallbladder and large polyps of the gallbladder (which lead to cancer).