Q. My sister was operated on last week. Her gallbladder was removed because it had stones. They did not open her up. They simply inserted some instruments into her abdomen that resulted in small round scars. Why did they remove her gallbladder instead of just the stones? What is the function of the gallbladder? Can a person live normally without it?

--Erlin A., Taytay, Rizal. 

A. The gallbladder (apdo, in Filipino) is a small, sayote-shaped organ that lies on the undersurface of the right lobe of the liver. It stores, concentrates, and acidifies the bile that is produced by the liver. Bile aids in the digestive process by emulsifying fat. When needed, it is released by the gallbladder into the small intestine.

The gallbladder is not a vital organ. It has a relatively minor function and one can live normally without one. In fact, removal of the gallbladder or cholecystectomy is the standard treatment for a diseased gallbladder.

The most common indications for cholecystectomy are gallbladder stones (which your sister had) and cholecystitis (i.e., infection of the gallbladder) that in 95 percent of cases is associated with the presence of gallstones. The presence of gallstones, however, is not an outright indication for cholecystectomy. Most people with gallstones do not have any symptoms and for these people, removal of the gallbladder is often not necessary. However, among people who present with symptoms, cholecystectomy is often advisable. Why is the gallbladder, not just the stones, removed? Simply because a stone is merely sign of a diseased gallbladder and unless the organ is removed, stones will likely form again.

Most cholecystectomies, as in the case with your sister, are now performed by laparoscopy—where the gallbladder and the stones are removed with the aid of small hi-tech instruments that are inserted through small incisions on the abdomen. Conventional open cholecystectomy is still performed, but only if the case is not amenable to laparoscopy or if the hospital lacks the needed equipment. Laparoscopic cholecystectomy is less traumatic than conventional cholecystectomy. People who undergo the procedure are able to go home a day or two after the operation and report for work in a week’s time.

Removal of the gallbladder entails some alteration in the flow of bile. There is no storage area for bile anymore hence bile goes directly from the liver to the small intestine. Despite this physiologic change however, cholecystectomy usually causes no change in the digestive process. Most people who undergo the procedure need no dietary restrictions and do not have any complaints.

However, 10 to 15 percent of people who undergo cholecystectomy experience continuing signs and symptoms. These signs and symptoms are either the same ones that existed before the operation or new ones that normally can be attributed to a diseased gallbladder. These signs and symptoms, which are collectively referred to as postcholecystectomy syndrome, include abdominal pain, flatulence, nausea, diarrhea, jaundice (yellowing of the skin), chills, fever and fatty food intolerance. 

Post-cholecystectomy syndrome occurs more often in women than in men. It is also more common in younger than older patients; and, in people who have had symptoms for a longer period before surgery.

People with post-cholecystectomy syndrome need to be examined and worked-up to determine and treat the cause of the signs and symptoms. Among the common conditions that cause the syndrome are: gallbladder remnants, stone in the biliary passages, biliary tract disease, post-surgical adhesions, and incorrect diagnosis prior to cholecystectomy.

Incidentally, some scientific studies have shown a positive association, albeit a very weak one, between cholecystectomy and subsequent cancer of the colon and pancreas. But these studies are far from conclusive.

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