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If you’ve had bariatric surgery, you’re already making big changes to your health. But rapid weight loss can also trigger side effects, and gallstones are one of the more common ones. While not every patient will have problems, some may need their gallbladder removed in the months or years that follow. Understanding why it happens, what to look out for, and how it’s treated could be useful for the future.
What does the gallbladder do?
The gallbladder is a small organ located under the liver. Its main job is to store bile, a fluid that helps digest fats. While there is always bile trickling out of the liver and into the small intestine, some is diverted into the gallbladder. When you eat, the gallbladder releases bile to mix with your food. If bile becomes too concentrated, it can form hard deposits known as gallstones. While gallstones can be present in people for some time without causing problems, in around 5% of people per year they can start to damage the gallbladder or surrounding organs, causing pain and other symptoms.
Why can gallstones develop after bariatric surgery?
Rapid weight loss after surgery changes the balance of cholesterol and bile salts in the gallbladder, making gallstones more likely to form. Eating smaller portions also means the gallbladder empties less often, giving bile more time to crystallise. In some procedures, like gastric bypass, there can also be changes to the nerve signals that control gallbladder contractions, which may further increase the risk.
How common is gallbladder removal?
While 10-20% of patients develop gallstones in the first year after bariatric surgery, only around 8% experience symptoms, and roughly 4% require gallbladder removal. The highest risk period is the first 6 – 18 months after surgery, when weight loss is at its fastest.
When surgery might be needed
Not all gallstones cause problems. “Silent” gallstones can be left alone, but if they cause symptoms such as sudden right-side upper abdominal pain (often after eating), nausea, vomiting or fever, then removal of the gallbladder – known as a cholecystectomy – may be recommended. If gallstones are found to be causing problems before bariatric surgery, the gallbladder can sometimes be removed during the same operation, although this does involve extra risks. Patients who have had gastric bypass surgery are usually counseled to consider having gallbladder surgery if they develop gallstones, because of the higher risks of gallstone complications after bypass surgery.
Recovery after gallbladder removal
Most gallbladder surgeries are performed laparoscopically, which means small incisions and a fast recovery. Patients are usually back to light activities within a week and fully recovered in two to four weeks. While the body can digest food without a gallbladder, some people may experience temporary changes in digestion. Eating smaller, more frequent meals and avoiding very high-fat foods in the early weeks can help.
Can gallstones be prevented?
Not all gallstones can be avoided, but following your bariatric team’s nutrition guidelines and staying hydrated may help. If patients are particularly worried about developing gallstones after bariatric surgery, they can ask to be prescribed a medication called ursodeoxycholic acid. This medication, which isn’t PBS subsidised, helps prevent the formation of gallstones but must be taken for 12 months or more following surgery.
Gallbladder removal after bariatric surgery is not inevitable, but it’s worth knowing about, especially during the rapid weight loss phase. By understanding the risks, recognising symptoms early and seeking prompt medical advice, you can stay proactive in protecting your health.
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