Post Surgery Gallbladder Removal

Good afternoon DSers!

Today was my six month post surgery follow up, woo! About three weeks ago I started having a dull, vertical pain in my abdomen between my rib cage and navel with the occasional sharp pain when bending or lifting. After waiting a week to discount stupid human tricks, I called the clinic and had an ultrasound scheduled, which was Friday.

During the follow up today, the APRN opened with the results. In super scientific medical terms, my gallbladder has "sludge". They can't tell if there are stones. He immediately moved to "once it's out" language, and now I have a surgical consult scheduled for Monday. I also, coincidentally, will be seeing my PCP for low energy and fatigue Wednesday and will ask about this from a medical perspective. The pain hasn't gone away and it's evolved to spread to the left and right a bit, so I know something needs to be handled.

So, the point. Two of them, actually.

We malabsorb fats - I've seen the proof! My clinic wants me on super low fat diet. I've been doing a moderate fat diet with an emphasis on healthier ones like avocado, olive oil, nuts, etc., mostly in hopes of being better able to absorb vitamin content. For those who have a DS and no gallbladder, or have had your gallbladder removed post-surgery, has that changed your eating habits or how your body has handled fats?

Second, anyone had something similar with "sludge" that didn't result in surgery? I'll be consulting Dr. Google but much appreciate the lived experience of the veterans here. Thank you!

I think Gallbladder issues go hand in hand with the DS procedure including the Sadi. So much so, my WLS surgeon told me he was going to just remove it as a precaution at the same time he performed my Sadi procedure in 2014.

Turns out he did not remove it, although I have not had any Gallbladder issues to date. I'm a believer in eating good fats anytime you like, as well as high amounts of protein, and any amount of fruits and fiber you like. It works well for me so far but everyone needs to evaluate what works for them.

Thanks for your response! It's interesting that your surgeon said he would and didn't. I'm glad it's worked out for you and that you've been able to keep it! From what I've seen since joining, you've been pretty darned successful with your surgery and eat a good amount of fat.

I asked during pre op if gallbladder removal was included (since the internet said it's pretty common) and got a resounding no at the time. Candidly, this is the fourth time I've lost more than 100 pounds, so that might be taking a toll after decades of ups and downs. Doesn't even include all the smaller losses.

Appreciate the diet feedback as well. I was just instructed to add back 15g of carbs per meal as of yesterday, so I'll get to have some fruit, whole grains, and fiber to see how that goes. The trick is he wants me to eat that at the same meal as the 3 ounces of protein and non starchy veggies. Ha!

Have a great day!

GB issues are endemic for almost anyone who has been heavy a good portion of their lives. This is why many DSers have the GB removed when they have their DS. I insisted mine be removed. Long standing joke in the ER, fat, female, over 40, presents with abdominal pain. The first thing to check is the GB.

I am just fine without mine and I can eat anything.

The reason your clinic wants you on a low fat diet is to lessen the possibility of GB attacks while you are waiting for surgery. Very painful as you already know. There really is no reason to keep it. You would just be waiting for it to fill up with sludge again. Or stones.

Postop start with lower fat and once you are healed most likely you will be able to eat as before.

Thanks for your feedback!

Good to know I fit the old ER saying. Well, not so fat anymore, but all the rest!

Appreciate the perspective. I guess treatment could be an option but it does appear that overall, the long-term odds on keeping it are not in our favor. Glad you're able to eat anything now!

Yep, I'm absolutely controlling fat right now. The pain is constant and growing over time but manageable. The moderate fat had been my adaptation of the general post-surgery plan, which all but eliminated everything but lean protein and non starchy vegetables until Monday. Since I'm already running into some deficiencies in my fat soluble vitamins, figured eating a bit more fat would help...just not for the next few weeks, or as you said, post-op for a while. My guess is they'll want this to move pretty quickly.

Have a good night, and thank you for continuing to share experiences for these questions!

This is a question for you, as well as a general question to anyone who's reading this: did your surgeon put you on Urso (ursodiol) for 6 months after surgery? Mine did - it helps the gallbladder during the massive weight loss phase immediately post-surgery. Everyone I know that had this prescription still has their gallbladder. Bear in mind that I had my DS 6/19/06, and this was my surgeon's protocol for all his WLS patients. I don't know if surgeons still do this.

I'm sorry to hear that your gallbladder went bad. I've heard the pain is awful and I hope it resolves soon.

Hey there!

Nope! Today is the first time I've heard of it, so of course had to Google it. Looks like it's still common practice, and recommended, even, so I'm not sure why this didn't come up. It definitely wasn't something I thought to ask, even with all the research beforehand. Since I'm having a surgical consult Monday, I'll be sure to ask him the logic since now I want to know. He also didn't prescribe the blood thinner injections afterwards, though other surgeons at the practice do. For that part, I was told it's up to individual practice.

Ultimately, I went home with painkillers I didn't use, a few anti-nausea pills that also weren't used, and omeprazole. Everything else is supplements.

Thank you for calling this out! I wonder about the experiences of all the other DS variant folks out there!

Just in case it might help someone to read this, I asked my surgeon why Ursodiol wasn't on my list of prescriptions six months ago. He mentioned some mixed reviews on it and said that he's seen it cause some issues where it makes the gallbladder empty when there is sludge or small stones that can then cause additional issues. I'm not convinced but it was ultimately his choice.

He definitely wouldn't give it to me now for that same reason. Surgery scheduled February 10th for removal to prevent complications. He thinks I have a very high pain tolerance for not opting to have it out tomorrow. Go figure.

Gallbladder problems are not unusual post WLS (any WLS) as the rapid weight loss can trigger it (maybe 10% or so run into it?) Our surgeon routinely removes the gallbladder on his DS patients, mostly since he has a lot of travelling patients, he doesn't want some general surgeon going in there and getting lost in the altered anatomy; in his sleeve patients like me he normally leaves it in unless he feels stones in there while he's working as the risk/reward balance is different.

I agree that your low fat prescription is likely temporary to avoid tickling the GB more than necessary for now, and then you can go back to, or evolve into, a more normal dietary balance. Some DSers we see online go overboard on the "full fat everything" which is fine, to an extent - some take it to the point of triggering additional bathroom, and even septic system, problems. Balance is still a key, and while with a DS that balance point may be biased more toward the fat side of things than normal, there is still a balance point to find. My wife is generally on what one would call a moderate to moderately high fat diet while I keep mine somewhat leaner as I don't have the malabsorption in play.

We haven't noticed any particular difference between her having had her GB removed, and mine still in there. One of those big YMMV things.

Thanks for sharing your feedback! It's good to hear both stories, and to know that your wife has been able to resume a normal diet for her after surgery.

I've definitely seen everything from "as much fat as possible" to my clinic's direction of super lean everything, so agree that it will be finding the balance that works. Of course, when I asked my clinic last July why they recommended low fat, their concern was loose stools and gastric issues and had nothing to do with gallbladder. You live, you learn!

Glad it sounds like you're both doing well. Cheers!