DEAR DOCTOR: How necessary is the gallbladder? I recently had two flare-ups of what turned out to be gallbladder attacks. My doctor said that if I have another attack, he would recommend removal of the gallbladder. But don't I need it?
DEAR READER: To begin to answer your question, let's first look at the liver, which is next to the gallbladder. The liver produces bile, which contains bile salts. These salts are secreted into the small intestine after eating, helping to emulsify fats so that they can be absorbed more easily. Some of the bile is also stored in reserve within the gallbladder. While bile is obviously important, the benefit of bile storage in the gallbladder is more complex.
Now we have to look at why your doctor is considering the removal of the gallbladder. Gallstones occur when the bile in the gallbladder is saturated with either cholesterol or bilirubin, formed by the breakdown of red blood cells. In the Western world, having gallstones is quite common. The problem with these stones is that they can lead to inflammation and infection of the gallbladder; they can also get trapped within the duct that leads to the small intestine. Both of these cases require surgery.
However, a gallstone can also block a duct leading from the gallbladder; this occurs when the gallbladder contracts during eating. The contraction of the gallbladder, in addition to the blockage of the duct, leads to increased pressure in the gallbladder and pain in the upper abdomen toward the right side. A fatty meal can cause greater contraction of the gallbladder and thus more pain.
To prevent further attacks of what is termed biliary colic, you could consider staying away from high-fat foods and taking medication to help dissolve the stone. However, the success rate of these combined measures in preventing further attacks is only 30 percent. To prevent more attacks, not to mention the possible complications of gallbladder or bile duct infections, the majority of people opt for the removal of the gallbladder. In fact, each year in the United States, 800,000 people have their gallbladder removed. Among those who have the surgery done electively for biliary colic, 72 percent have a resolution of symptoms; for the others, the symptoms turned out to be unrelated to gallstones.
As for whether the gallbladder is necessary, consider the aftermath of gallbladder removal. Because bile is helpful for the absorption of fats, one would think that gallbladder removal would create a problem in this respect. That's not the case. The liver still produces the bile needed to absorb fats.
One symptom that does increase after gallbladder surgery is flatulence. The reason is unknown, but the symptom doesn't appear to be physiologically serious.
Undoubtedly, there are benefits to having a gallbladder, so make sure your symptoms are related to the organ. That said, you can live a long and healthy life without a gallbladder. Here's the take-home message: Recurrent attacks of biliary colic would indeed seem to warrant removal of the gallbladder, not only to prevent further attacks, but also to decrease your chance of future gallbladder infection.
(Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.)
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