Gallbladder problems after bariatric surgery is a common and treatable complication of fast weight reduction, perhaps the most preventable complication within the realm of bariatric surgery. If patients plan ahead and take the medication they can avoid problems with gallstones.
Even if gallstones do develop treatment is usually straightforward. Does not require a hospital stay. This guide will explain why bariatric surgery increases the risk of gallstones how to recognize the symptoms and what to do if surgery is needed.
At BodEvolve Bariatric Surgery Center in Texas, Dr. Frenzel and Dr. Holt see patients who have had surgery. They notice that patients who understand the risks and follow prevention plans have complications.
It is essential to be honest about the risks. Getting gallstones after surgery does not mean that something went wrong with the operation. It is a response to losing weight quickly. Patients can plan for this. Take steps to prevent it.
Why Does Bariatric Surgery Cause Gallstones?
With the approach most patients can avoid needing a second surgery. So why does bariatric surgery cause gallstones? It is not the surgery itself. What happens when patients lose weight quickly.
There are a reasons why this happens:
1. When the body loses fat quickly it releases a lot of cholesterol into the blood. This cholesterol can form crystals in the bile, which can become gallstones.
2. After surgery patients often eat very small meals. This does not stimulate the gallbladder enough to empty it between meals. As a result bile sits in the gallbladder for longer allowing cholesterol crystals to form stones.
3. Gastric bypass surgery can also change the way the gut signals the gallbladder. This can make it harder, for the gallbladder to empty which can increase the risk of gallstones.
4. Eating a very low-calorie diet can also increase the risk of gallstones. This is because the body is not getting energy, which can affect the way the gallbladder works.
Caloric restriction, in and of itself. Very low-calorie diets, even without the use of surgery, can greatly increase the probability of developing gallstones, and case of gastric sleeve surgery or gastric bypass, where fewer than 800 calories are consumed on a daily basis, this effect lasts for many months.
It is precisely because of this combination of circumstances that individuals losing weight rapidly post-bariatric surgery have an elevated risk of developing gallstones compared to the average person.
How Common Are Gallstones After Bariatric Surgery?
All studies done on bariatric surgery show increased incidences of gallstone formation compared to the general population.
A. Gastric bypass: Gallstones form in 25-40% of patients after gastric bypass within the first year postoperatively. A third of those patients will be symptomatic and need to undergo cholecystectomy.
B. Gastric sleeve: A slightly lower proportion of patients, around 10-25%, will develop gallstones after gastric sleeve surgery. Only a portion of these individuals are expected to become symptomatic. The reason for that is a less intense hormone effect following this type of surgery.
C. Duodenal switch surgery or SADI procedures : Patients who undergo duodenal switch and SADI surgeries lose weight at an even faster pace; therefore, the incidence of gallstones is comparable to or even exceeds gastric bypass patients.
Gallstones in the general population: 10-15% of adult individuals who do not undergo bariatric surgery will develop gallstones throughout their lives. On the contrary, people who undergo bariatric surgeries get gallstones almost as often as that in 6-12 months postoperatively.
Honest statement for patients: one out of three patients after gastric bypass surgery develop gallstones within the first year postoperatively (no prophylactic treatment).
Symptoms of Gallbladder Problems After Bariatric Surgery
The symptoms of gallbladder problems after gastric bypass procedures are essentially identical to those in the regular population; however, they usually arise at a point in the healing process where patients are acclimating to bariatric eating and may miss the signs.
Classic symptoms include:
1. Episodic sharp pain in the upper-right abdomen (30 minutes to several hours)
2. Pain that increases after eating, particularly fatty foods
3. Right shoulder or back pain that radiates from the source
4. Nausea or vomiting after eating
5. Bloating/indigestion
6. A fever with chills (occurs if there is an infection present)
7. Yellow skin or yellow whites of the eyes (jaundice – suggests blocked bile ducts)
8. Dark urine or light-colored bowel movements (also suggests blocked bile ducts)
Why bariatric patients sometimes miss the symptoms:
Because bariatric patients eat smaller meals and have digestive discomfort, even minor gallbladder pain may go unnoticed. Recovery patients may mistake gallbladder pain with dumping syndrome or foamies after bariatric surgery associated with bariatric surgery. Patients who believe that their symptoms are related to their bariatric procedure, rather than another ailment
When to call your surgeon immediately:
1. Pain lasting over 4-6 hours
2. Pain accompanied by a fever, chills, or vomiting
3. Yellow skin or eyes
4. Dark urine or light bowel movements
Where Is Gallbladder Pain Located?
Those looking for the answer to “where is gallbladder pain located?” will often find that it occurs in one particular place. It can help them discern their condition from others.
Primary pain location: The gallbladder is situated directly beneath the liver on the right-hand side of the abdomen. The pain usually starts at the top of the right-hand part of the abdomen, which is about 2 to 3 inches below the right ribs in the abdomen.
Radiation patterns: The common pain locations where gallbladder symptoms start to radiate include:
1. Right shoulder or between the shoulder blades
2. Upper back, specifically the right-hand side
3. The center of the chest area (may be mistaken for heart-related pain)
4. Right side of the neck
For female patients: The gallbladder pain location for female, the location of gallbladder pain remains the same as described above; however, there is one important difference. Women have a higher risk of developing gallstones than men, especially if they had bariatric surgery.
For male patients: The gallbladder pain location for male, the location of gallbladder pain will be identical. Male patients have less tendency to form gallstones, but when formed, they usually show similar symptoms.
Pain timing characteristics:
1. Appears abruptly within 1-2 hours after eating
2. Duration ranges from 30 minutes to many hours
3. Worse at nighttime or after eating fatty meals
4. Pains could occur repeatedly for weeks or months before they become consistent
5. Differentiating gallbladder pains from other post-surgery pains:
6. Dumping Syndrome: Generalized abdominal pain with rapid heartbeat, sweating, and frequently diarrhea – appears within 30 minutes after consumption of sweets or carbohydrates
7. Foamies/Regurgitation: Throat and chest pain with foaminess in the mouth – linked with eating too fast or food with an incorrect texture
8. Stomach ulcers: Upper middle abdominal burning sensation that gets better when eating
9. Gallbladder pain: Sudden sharp pain confined to the right side – appears after meals containing fats and radiates towards the back and shoulders
If your pain does not conform to the above description, check the diet after gastric sleeve or post-bariatric surgery diet guides for information.
How to Prevent Gallstones After Bariatric Surgery
Prevention is achievable in most cases. There is one preventive measure that has proven to be very efficient; it involves using the drug ursodiol together with other methods such as diet control and behavioral changes.
Ursodiol (Actigall)- The Primary Prevention Tool
Ursodiol for gallstones, alternatively known as Actigall, is a drug that inhibits saturation of bile with cholesterol, which helps prevent crystal formation and subsequently leads to gallstone development. Studies have revealed that with ursodiol treatment, gallstone development after bariatric surgery can be prevented in up to 70-80 percent of cases.
How ursodiol works:
1. Ursodeoxycholic acid (chemical structure of ursodiol):
2. Decreases cholesterol absorption in the intestines
3. Lowers cholesterol output in bile
4. Dissolves existing crystals
5. Inhibits formation of new crystals
Dietary and Behavioral Prevention
In addition to Ursodiol, other prevention measures from the diet and behavioral aspect include:
Do not underfeed yourself with calories. Following your surgeon’s recommendation regarding the appropriate calorie intake (which will generally be 800-1200 per day for the first 6 months) is more effective than underfeeding yourself. See pre-bariatric surgery diet and post-bariatric surgery diet guides for appropriate calorie consumption levels.
Take your prescribed vitamins. Studies show that there might be a link between vitamin deficiencies after bariatric surgery and gallstones.
Related Complications Patients Should Know
There is more than one complication associated with the quick weight loss after bariatric surgery. Some other complications which should be highlighted include:
Liver Problems After Gastric Bypass
The Liver problems after gastric bypass, though this condition will be different from any liver condition experienced before the operation. A pattern observed here includes:
1. Patients scheduled for bariatric surgery already suffer from NAFLD or NASH as a result of obesity
2. Quicker weight loss following the surgery resolves fatty liver disease for most patients
Other Post-Op Complications to Monitor
A patient should also watch out for:
Hair loss after bariatric surgery – Temporary and associated with quick weight loss
Depression after bariatric surgery – Can occur among patients during adaptation time
Weight loss stalls – Normal, though difficult for the patient emotionally
Foamies and regurgitation – Commonly associated with quick eating and food intake
Dumping syndrome – Occurs after gastric bypass surgery with sugar-filled foods
All these complications are common post bariatric surgery complications. The more a patient communicates with their surgical team, the easier it will be to address them.
When to Call Your Bariatric Surgeon
Your bariatric surgeons should be contacted in case you develop:
1. Sharp pain in your upper right abdomen that lasts several hours
2. Pain that gets worse when eating fatty foods
3. Right shoulder and back pain
4. Yellowing of your skin and whites of your eyes
5. Dark-colored urine and clay-colored stools
6. Abdominal pain accompanied by fever
7. Severe nausea or vomiting
Gallstone pain starts as infrequent and easily tolerated discomfort – but as time passes, it progressively gets worse. When patients take action early enough, they have easier procedures compared to those who ignore their symptoms until they worsen. The team at BodEvolve offers their expertise to bariatric surgery patients all over Dallas, Arlington, Richardson, Texarkana, and other locations near the DFW area. The practice has two surgeons who specialize in treating gallbladder problems in bariatric surgery patients and can schedule gallbladder surgery accordingly.
Talk to a BodEvolve Bariatric Surgeon
Postoperative gallbladder problems are frequent, expected, and very preventable following bariatric surgery. The patients who tend to fare the best in recovery are those who understand the risk prior to surgery, take ursodiol prophylactically post-surgery, and identify early signs of symptoms if they arise.
For individuals interested in surgery such as gastric sleeve, gastric bypass, duodenal switch, or SADI, or even considering a medical weight management such as GLP-1s in order to manage weight, the BodEvolve doctors take the time to guide you through every step of the process, including prevention of potential complications.
With over 14,000 cases under their belts, an ASMBS Center of Excellence designation, and Doctors Clayton Frenzel & Brian L. Holt, two board-certified bariatric surgeons, your safety and comfort will be taken care of.
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