Just seven emergency surgeries account for 80% of all admissions, deaths, complications... and costs to the patient.
Research published in JAMA Surgery found that the majority of these problems resulted from one of four different bowel surgeries (partial colectomy, small-bowel resection, removal of peritoneal adhesions, and laparotomy), as well as removal of the appendix, peptic ulcers, and gallbladder.
Last week, we talked about how to treat a common problem after gallbladder surgery.
But here's something I didn't address...
Too many gallbladder surgeries are unnecessary.
Your gallbladder has an important role. Your liver produces bile, a substance that breaks down fats into fatty acids and fat-soluble vitamins, which your body absorbs. Although the liver directly pumps bile into your intestines during digestion, extra bile is stored in the gallbladder. If you eat anything with higher amounts of fat, your gallbladder pumps that extra bile into your system to help break down the food.
This is why many foods high in fat trigger gallbladder problems, including fried foods and dairy.
Symptoms of gallbladder distress include pain in the upper right of your abdomen or just below your breastbone, pain in your right shoulder or between your shoulders, nausea, and vomiting.
You can develop stones in your gallbladder or suffer from chronic inflammation. Most of the time, these episodes resolve on their own and you can go years without another bout. But sometimes the stones move and lodge themselves into the ducts connecting your gallbladder, liver, or pancreas to your intestine. That can inflame your liver or pancreas, too.
In these cases, your doctor would likely recommend removing your gallbladder.
Gallbladder-removal surgery is called a "cholecystectomy" ("cholecyst" is from the Latin word for gallbladder and "-ectomy" is from Greek for removal). It used to be only for urgent cases because it required serious abdominal open surgery. It took weeks to heal.
But with the advent of robotic surgery, patients could get the procedure done through a few very small incisions and leave the hospital the same day. A few studies show that the number of surgeries grew as a result, with one study in Ontario reporting a growth of about 30% in the years that followed the birth of laparoscopic surgery in the late 80s.
Today, surgeons remove nearly 700,000 gallbladders a year. Surgical robots perform 90% of them.
Now, most of the time, gallstones may pass on their own or remain symptom free. Simply changing your diet and losing weight can help keep further stones from forming. But many doctors recommend removal even if you don't have gallstones or signs of disease.
For instance, more than a quarter million Americans land in the hospital because of acute pancreatitis each year. According to a study from Johns Hopkins, about 80% of these folks elect to get their gallbladder out even though it may not be the only cause.
The interesting part... 70% of those who didn't get the surgery remained symptom free four years later.
If you're having what you suspect is gallbladder distress, try a few things first. Cutting out fatty and fried foods and reducing your consumption of dairy will help. Also keep a food diary to track what could be your trigger foods. Even things like peanut butter might trigger symptoms from the fats present.
In addition, aim to lose weight. Obesity puts a strain on our livers, which can lead to cholesterol buildup that forms gallstones. And adding in regular exercise helps reduce your risk of developing gallstones.
What If I Need Surgery?
Of course, there are some cases where surgery is necessary in emergency situations. This happens if the gallbladder is close to rupture (or has ruptured). If it tears or bursts, bile leaks out into the body. That can lead to sepsis and toxic shock, which is deadly.
After removing the gallbladder, you're at risk for a few things. For example, many folks experience diarrhea after every meal. However, this usually stops after a few weeks. If it doesn't, try changing your diet to eliminate or at least reduce trigger foods (remember, anything with fat, including dairy). We also recommend fiber and probiotics to help keep your gut healthy. If it doesn't stop, be sure to talk to your doctor.
There's also something called postcholecystectomy syndrome (PCS). It affects 10% to 15% of patients long-term and involves problems with continued bile flow into the intestines. It can cause things like flatulence, bloating, diarrhea, heartburn, and nausea. There are a number of causes, and if you experience these things more than a few weeks after surgery, you should see a doctor. It could be something serious, like a gallstone that's still stuck in your liver duct, for instance.
Gastrointestinal problems like gallbladder disease interfere greatly with daily life. That's why we recommend taking steps like losing weight, eating well, and exercising to prevent gallbladder problems whenever possible.
What We're Reading...
- Did you miss it? Our Q&A with a question on gallbladder disease.
- More on exercise and your gallbladder.
- Something different: What is wrong with millennials?
Here's to our health, wealth, and a great retirement,
Dr. David Eifrig and the Health & Wealth Bulletin Research Team
April 12, 2018