6 reasons why gallbladder surgery fails 1/3 of the time

A pile of gallstones removed from all of these gallbladders would reach the moon!

Gallbladder removal is one of the most common GI surgeries performed yearly in the US. After the advent of the laparoscopic procedure in the 80s, rates of removal went even higher. Currently, 750,000 gallbladders are removed each year. The procedure is quite safe, with less than 1% complication or mortality rate.

Yet, as safe and as common as it is, a whopping ONE THIRD of procedures do not resolve symptoms, leaving 250,000 people yearly still struggling, frustrated and perplexed.

Part of this is because many docs are quick to blame the gallbladder without fully working up other possibilities.

And part of this is because some docs don’t follow the criteria for recommendation of surgery, which means that many surgeries are not indicated.

Any surgery will have the best possible outcome when it is indicated, and a less helpful outcome when it’s not indicated/unnecessary.

Gastroenterological advisory boards (consisting of medical doctors and surgeons) establish criteria to recommend or exclude folks for gallbladder surgery.

The criteria for gallbladder removal are simple:

1. A person is symptomatic with biliary pain. Biliary pain must be clearly defined, and the boards have their ideas on that: episodic, steady, severe upper right quadrant pain lasting more than thirty minutes. This pain often has the accompanying symptoms of nausea, vomiting, night-time onset and pain that radiates to the back.

2. An ultrasound has revealed the presence of stones. There must be evidence of stones. This is IMPORTANT. There are mountains of data and research that definitively state that without stones, there is little indication for surgery and symptoms will not be resolved with removal. Many still plunge ahead – despite the warnings of their boards and the research.


Reasons why surgery fails:

1. You did not meet criteria for surgery: presence of stones verified by ultrasound AND biliary pain.

2. You were misdiagnosed. Make sure your doctor rules the following out.

IBS: all variety of pain, spasm and cramping can occur with IBS. Virtually all symptoms attributed to gallbladder pain can also be found in IBS. IBS is no longer a wastebasket diagnosis. It is characterized by microbial imbalance and enteric nervous system (ENS/the “Second Brain”) dysfunction, and there is even a blood test for it now.

SIBO (small intestine bacterial overgrowth): SIBO is often found hand-in-hand with gallstones and I recommend that it be treated first to see if it helps with symptoms. IBS and SIBO often run together as well.

Ulcer/gastritis: if surgery is recommended, it is worth having a less-invasive endoscopy to rule out ulcer or gastritis (non-specific inflammation of the stomach).

Dyspepsia: this is a fancy way to say indigestion (reflux/belching/burning can accompany) and is often due to food sensitivities, excessive stress or IBS.

Food sensitivities: Sometimes, we eat foods that are not right for us, and we don’t know it. These foods then can create a whole host of symptoms both within the gastrointestinal system and in seemingly far-flung areas too.

Functional gallbladder disease (without stones): Sometimes, biliary pain can be present without the presence of stones.

In this case, the pain is often caused by increased pressure in the gallbladder as the gallbladder contracts against an obstructed outlet. The outlet can be obstructed by thickening (that can be present in other biliary diseases) or by uncoordinated movement of the gallbladder..

3. Digestive fire issues. If your pain/symptoms begin at mealtime or within 30 minutes of eating, it could be that you simply need bile support.

The gallbladder’s job is to store bile until it is required to help with fat digestion. Normally, when we begin to eat a meal the gallbladder will contract and release bile so it is available to help with the emulsification and digestion of fats.

Your liver is still making bile, even without a gallbladder. But without a storage tank to hold it until needed, bile may not be present when required – at mealtime! Fatty meals (fried foods, avocado, coconut, oils, nuts, seeds, fatty cuts of meat) will highlight this for you.

So, if bile production and availability is willy-nilly, taking bile support with your meals can be a game changer.

4. Scar tissue. Random, episodic pain that stabs and shoots and radiates, after surgery?

Could be due to scar tissue. Scar tissue pulls on other tissues and structures and can create pain. The more scars you have (from a C-section, appendicitis or other abdominal or hip surgery) the more this effect can be amplified.

Some folks make more scar tissue than others. If you have keloids (thick scars) on your skin, you can also assume you have those inside as well. This will change the movement and fluidity of your fascia and connective tissue, which can trigger pain.

However, you don’t have to form keloids to have pain from scars.

I have seen dozens of cases get extreme relief from pain by finding a visceral manipulation practitioner to work on their scars. Find a practitioner.

5. Visceral hypersensitivity: Sometimes, symptoms of pain and spasm don’t resolve because of a nervous system issue.

Visceral hypersensitivity is an unfortunate state when the threshold at which our nerve cells register pain is lowered.  This means it takes less stimulation to the pain receptors to get a pain response.

In other words, visceral hypersensitivity is a state in which you feel pain more easily. It has nothing to do with toughness and fortitude, but with what your nerves are registering.

Visceral hypersensitivity is often caused by dysautonomia, a condition where the “fight or flight” (sympathetic)  and “rest and digest” (parasympathetic) branches of the autonomic nervous system become imbalanced, often towards dominance of the “fight or flight” side.

Other symptoms of dysautonomia are dizziness, sleep disruption, sensory overstimulation, being sensitive to lifts, smells, sounds, textures, clothing, feelings of anxiety or near panic for no discernible reason, and problems with focus and concentration.

In dysautonomia, there is no getting around deep, real de-stressing techniques. I often recommend biofeedback, cognitive behavioral therapy, limbic system retraining, Heart Math or similar in these instances.

6. Sludgy bile. When surgery fails, and all of the oft-misdiagnosed conditions are ruled out, and you’ve got great digestive fire, aren’t bogged down by visceral hypersensitivity or scar tissue — we are left with the bile itself.

What is often attributed to the gallbladder is actually a bile issue.

This was a major motivating factor or why I had to create the Gallbladder & Liver School and create a framework that targets the bile itself, helping it to be nice and thin to do its many jobs.


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