Gallstones After WLS: Causes, Symptoms and TreatmentsMarch 15, 2019
Gallstones are common with individuals that are obese. This tendency for having gallstones is an issue that bariatric surgeons know from performing bariatric surgery on patients. For many pre-op patients, surgeons will order a gallbladder scan as one of the pre-op tests.
Historically it is well known that within the multiple risks that lead to gallbladder problems, morbid obesity is one of the most common and important ones.
Gallstones After WLS: Causes
The primary cause of gallstones is due to a patient’s obesity. It is obesity that places a patient as a candidate for weight loss surgery. This is due to the fact that obesity promotes the concentration of high cholesterol levels, calcium and acid in bile as well as reducing the flow of bile thru it’s conduits. The result is gallstones in an obese patient.
Given the significant increase in patients having bariatric surgery in the last few years, it is known that another risk factor for developing this problem is the rapid weight loss caused by bariatric surgery.
This is especially true in procedures where there is a gastric division like in the case of the gastric sleeve and gastric bypass surgeries. This is because these surgeries alter the production of certain hormones like Cholecystokinin and also interrupt certain nerve routes to the gallbladder which translates in the formation of stones in the early post-bariatric surgery stages. This is associated with interruption in the movement of the gallbladder where fasting and the strict diet following surgery further exacerbate the slow flow of bile.
Gallstones After WLS: Symptoms
Today we know that the incidence of gallbladder problems in the general population is between 5 and 30%; in post-bariatric patients this increases to 30 to 53% among which around 7 to 15% develop symptoms that require a cholecystectomy, these include abdominal pain in the upper right quadrant, nausea, vomiting, and reflux symptoms which are not different from patients that have not undergone a bariatric procedure.
If you are concerned about the possibility of having gallstones, discuss with your bariatric surgeon or primary care physician.
Gallstones After WLS: Treatments
Even with the increased risks, there are multiple studies that conclude that removing the gallbladder as a preventive measure is not justified and should only be done in those patients that already present symptoms or inflammation.
Those who promote the cholecystectomy at the same time as bariatric surgery as a preventive measure argue that it eliminates the diagnosis dilemma of atypical symptoms frequently present in the immediate post-surgery period and eliminates the risks of stones in the conduits which treatment can be particularly difficult in patients with a gastric bypass. Those who oppose it argue that even with the higher incidence of gallstones after bariatric surgery, cases of cholecystectomy remain under 15% and that removal at the time of bariatric surgery is associated with a longer hospital stay, longer surgery time and potential increase in surgery risks.
The debate over the best option is still ongoing, but in the last decade, there has been a decline in the practice of routine preventive cholecystectomy. Some attribute this to the prevalence of laparoscopic bariatric procedures that leave minimal adhesions after surgery which in the case that cholecystectomy is in fact needed after surgery it is much less difficult to perform than after open bariatric procedures.
If your surgeon determines that it is necessary to remove your gallbladder after having bariatric surgery, you’ll be able to live a healthy life without a gallbladder.
Under certain conditions, medication is available from your health care provider for any gallbladder issues before and after your surgery.
Make sure to discuss any concerns you have regarding your gallbladder being removed when you are discharged from the hospital or at one of your bariatric surgery follow-up appointments.
ABOUT THE AUTHORDr. Antonio Esquerra studied under Dr. Gilberto Ungson, Mexico's No. 1 DS surgeon and is now operating alongside him at Mexicali Bariatric Center. He received specialized laparoscopic training under Dr. Gilbergo Ungson with expertise on single anastomosis gastric bypass, gastrointestinal bleed and anastomosis leaks in gastric bypass, as well with post-op complications of the bilopancreatic diversion with nutritional support needed.