Post Date: 6/22/08 11:02 am
the purpose?  rapid weight loss = higher risk of gall stones = 2nd surgery to remove your gall bladder.  It is almost standard with most DS surgeons, some DS surgeons are saying "only if necessary"...hey to avoid a 2nd surgery, I'd say IT'S NECESSARY...lol.   I've read accounts by DSers and RNYers who had to go in for emergency surgery to remove their gall bladders a year or less post op, and it just makes me so thankful mine was taken out at the time of my DS too.   They normally take out the appendix too, because if you start having stomach pains it eliminates the appendix as the cause. Scott

Post Date: 6/22/08 11:29 am
There's a drug some surgeons put their patients on instead of removing the gallbladder. It's called Actigall, I think, and it's supposed to prevent the formation of stones. You might consider staying on it while you are losing weight.

Post Date: 6/22/08 12:01 pm
TELL your surgeon that you want it done! I am glad that I dont have to wonder if any pain I might have is gallbladder or appendix!!!

Post Date: 6/22/08 12:33 pm
Not only is there a high risk of the gall bladder getting stones (and the PAIN and risk of pancreatitis attendent to gall stones), but after the DS, there is NO POINT to having one.  The gall bladder stores bile produced by the liver, so that it can be released in a bolus in response to high fat meals to help digest the fat.  This was very important as humans (and other carnivores) were evolving, because meat meals rely on hunting, and there were long periods of no meat punctuated by gorging on a kill to eat it before it rots.  Obviously, this is NOT how we eat now. After the DS, our bile is kept separate -- deliberately -- from the alimentary tract.  It (and the pancreatic enzymes) dribbles down the biliopancreatic limb to join whatever food it happens to meet at the common channel.  I don't believe the gall bladder even gets the signals from eating a high fat meal after the DS, because those are triggered by receptors in the portion of the gut that is no longer in the alimentary tract, and thus the food can't trigger the receptors.  Therefore, the gall bladder has NO PURPOSE for DSers, and is only a potential source of problems. I too questioned Dr. Rabkin about why he would need to remove a perfectly healthy organ, should he find that mine was healthy.  He explained the above, and I agreed.  I was kind of hoping he would find that I had sludge in my gall bladder which would explain the several bouts of severe gut pain I had had over the years -- but nope, he removed a perfectly healthy gall bladder.  Apparently, the pain I had was IBS.  But I haven't missed my gall bladder one bit. As for the appendix, it doesn't have a purpose in the first place, so removal with ANY abdominal surgery is routine.  In fact, I had had three previous abdominal surgeries before my DS, and in two of them (they didnt' bother during the C-section), the surgeons had TRIED to remove my appendix and had been unable to find it.  In fact, the second surgeon told me my appendix had obviously been removed during the first surgery, because he had seen the scar!  Well, I knew that wasn't true (unless it was when I was abducted by aliens!) -- I had even been diagnosed with appendicitis in my early 40s, which had resolved without surgery.  Then when I had a barium enema study (trying to diagnose my IBS), it clearly showed my appendix -- in a very unusual position.  Insteaad of being at the junction of my small intestine and colon in the lower right quadrant, it was up much further and on the back side of  my colon, up under my liver -- a retrocoecal appendix.  So when I had my DS, I brought the Xrays of the barium study to Rabkin so he could track it down and remove it, finally.  It took him an extra hour plus in surgery, plus two extra lap holes to reposition the instruments to get it, but I finally had it out. In addition to the reasons above, not having a gall bladder or appendix simplifies the differential diagnosis of belly pain for us DSers -- we have enough complicated reasons for belly pain that are out of the ordinary, including adhesions, kinked bowels, Peterson's hernias and issues with blockages in the biliopancreatic limb which do not have the expected symptoms of intestinal blockages (because we can still poop and fart with a biliopancreatic bowel blockage, since it is not in the alimentary tract) that being able to rule out two common causes of belly pain is important to make the proper diagnosis more quickly.

Post Date: 6/22/08 1:25 pm
I was insistent mine be removed.  I didn't want a second surgery.  To add to what everyone else said.  My mom who went to nursing school in 1945 told me if you are fat, female, and over 40.....you're going to have problems with it.  So this isn't something new.  They knew about it before 1945. Truth is anyone who has been fat a significant part of their lives is probably going to have trouble with it.  And like Diana said, we don't need it anyway.  I didn't care if it was healthy or not.....it's outa there!

Post Date: 6/22/08 2:22 pm
Probably because I was so adamant about it.  Even at the first visit.  GB removal was right at the top of my list.  Flat told him I didn't care if it was so healthy it was dancin a jig.......I wanted it gone! He asked why too.  And I told him I didn't want to have to have another surgery in 6 months.  I also told him I was fat, female, and over 40.  Not much chance it's a good gall bladder anyway! People tend to hem and haw with doctors.  Because OMG, they are a DOCTOR.  I listen, I evaluate, I make up my own mind.  And since I'm the one with the dough, I get what I want.  Or I get another doctor. Buchwald tries to see what you know.  If you are insistent and have medically sound reasons why you want whatever, he will do it.

Post Date: 6/22/08 2:23 pm
Actually, the risk factors are the five "Fs": female, fair, fat, forty, fertile. I've known a few other women who needed their gall bladders out: 1)  Female, fair, fertile 2)  Female, fair, fertile (a couple of months after she had a baby) 3)  Female, fair, fat, fertile (and close to forty) 4)  (My mother, in January): female, fat, somewhat fair, and WAY over forty.

Post Date: 6/22/08 1:36 pm
My surgeon routinely removes the GB and appendix during DS's.  Her reason was also to eliminate the two common diagnoses for abdominal pain and the liklihood of gallstones.  Now, she tested it to see if she could charge for it, but I'm thankful for her doing so every time I hear of someone with wls going in within as little as a few months to get theirs removed.

Post Date: 6/23/08 8:43 am
After watching all 3 of my siblings have their gall bladders removed under "adverse" conditions (read: pain, agony, emergency surgery).  I was thrilled to learn that mine would come out with my DS.  Although, it ended up be a healthy gall bladder -- I say good riddance. 

Does your family have a history of gall stones? That might encourage your surgeon to remove it.  I've seen many, many post-ops end up having a second surgery soon after WLS so, if it's a 'deal breaker', you may want to look for a surgeon who will take it out.  Just sayin'.