Gallstones After Gastric Sleeve Surgery

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Gallstones After Gastric Sleeve Surgery

Losing weight quickly raises the chance of gallstones, and the months after a gastric sleeve are a period of rapid loss. Most stones cause no trouble. Some cause attacks of pain under the right ribs and lead to gallbladder removal. A medicine called ursodiol is sometimes prescribed for the first months to lower the risk. Fever, yellow skin or pain lasting hours needs urgent care.

Why rapid weight loss causes gallstones

The gallbladder is a small pouch under the liver. It stores bile, a fluid that helps digest fat, and squeezes it into the intestine when you eat. Gallstones are hard lumps that form when the substances in bile fall out of balance.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) explains two things that happen when weight comes off fast. The liver releases extra cholesterol into the bile, and the gallbladder may not empty properly. Cholesterol-rich bile sitting in a sluggish gallbladder is how stones form. NIDDK also lists obesity itself as a risk factor, so some people already have silent stones before surgery.

How often it happens after a sleeve

Figures differ between studies depending on how long patients were followed and whether stones were looked for with ultrasound or counted only when they caused symptoms. One U.S. study gives a sense of scale. At a Florida bariatric center (Moon and colleagues, Surgery for Obesity and Related Diseases, 2014), 6.1% of 115 sleeve patients who still had a gallbladder went on to need it removed for symptomatic stones. The figure after gastric bypass was 5.7%, not a meaningful difference, and no gastric band patients in that study developed symptomatic stones, which the authors attribute to slower weight loss.

In a larger Dutch trial (UPGRADE, Lancet Gastroenterology & Hepatology, 2021), 9.7% of bariatric surgery patients who took a placebo had symptomatic gallstone disease within 24 months. Most people in that trial had a gastric bypass, so it is only a rough guide for a sleeve.

Symptoms of a gallbladder attack

NIDDK describes a gallbladder attack as pain in the upper right abdomen, sometimes lasting several hours. Attacks often follow heavy meals and usually occur in the evening or during the night. After one attack, more are likely.

After a sleeve it is easy to blame every upper abdominal pain on the surgery. Pain that comes in episodes, sits on the right, and arrives after eating, particularly months after your operation, is worth reporting. An abdominal ultrasound is a common test for gallstones.

Prevention

Ursodiol

Ursodiol (ursodeoxycholic acid) is a bile acid taken by mouth. NIDDK states that it can help prevent gallstones in people who lose weight rapidly, including after weight-loss surgery, and notes that some health care professionals prescribe medicine for about six months after an operation to help prevent gallstones.

The evidence favors it overall, with less data for the sleeve specifically:

A 2022 meta-analysis of 11 randomized trials (Mulliri and colleagues, Journal of Gastroenterology) found that ursodiol after bariatric surgery reduced gallstone formation, symptomatic gallstone disease and the need for gallbladder removal. The authors report similar results in the subgroup who had a sleeve.
In the UPGRADE trial, 985 patients were assigned to ursodiol 900 mg daily for six months or placebo. Symptomatic gallstone disease occurred in 6.5% on ursodiol and 9.7% on placebo, a difference that did not reach statistical significance overall. The benefit was clear in people who had no gallstones at the start and absent in those who already had silent stones. Only 8% of participants had a sleeve, too few for the authors to draw conclusions about that operation.

Whether ursodiol is prescribed for you is an individual decision. Ask your surgeon whether it is advised in your case and for how long. NIDDK also suggests talking with your doctor before weight-loss surgery about how to lower your chances of gallstones.

What you can do

Fast weight loss is expected after a sleeve, so do not skip meals or cut food further to try to protect your gallbladder without asking first. Follow the eating plan you are given. If ursodiol is prescribed, take it as directed.

Treatment if stones cause symptoms

According to NIDDK, gallstones that cause no symptoms usually need no treatment. Once they cause attacks, the usual treatment is surgery to remove the gallbladder, called cholecystectomy. Nearly all are done laparoscopically, through small incisions, and many people go home the same day. NIDDK notes that the gallbladder is not an essential organ and people live normally without it, though some have looser stools for a while.

Having a sleeve does not prevent gallbladder surgery later. If a stone slips into the main bile duct, a gastroenterologist can remove it with a scope passed through the mouth (ERCP). That remains possible after a sleeve because the route from the stomach to the intestine is unchanged.

When to call

Go to an emergency room or call 911 if

NIDDK advises seeing a doctor right away for any of these during or after a gallbladder attack:

Abdominal pain lasting several hours
Fever, even a low one, or chills
Yellowing of the skin or the whites of the eyes (jaundice)
Tea-colored urine and light-colored stools
Nausea and vomiting with the pain

These can mean an infected gallbladder, a blocked bile duct or an inflamed pancreas. In the first weeks after a sleeve, severe abdominal pain with fever or a fast heart rate should also be checked for a surgical complication; see emergency warning signs after a sleeve.

Call the office if

You have had one or more episodes of right-sided upper abdominal pain after meals that settled on their own
Ursodiol is upsetting your stomach and you are thinking of stopping it

Frequently asked questions

Should my gallbladder be removed at the same time as my sleeve?

Not routinely. NIDDK notes that stones without symptoms usually need no treatment, and most sleeve patients do not go on to need gallbladder surgery; in the Moon study 6.1% did. If you already have painful gallstones before your sleeve, removal at the same operation may be discussed. Ask at your consultation.

When is the risk of gallstones highest after a sleeve?

The risk follows the pace of weight loss, which is fastest in the first months. That is why ursodiol, when it is used, is given for about six months and why the UPGRADE trial followed patients for 24 months. A gallbladder attack can still occur later, so new right-sided pain is worth reporting at any point.

Does ursodiol have side effects?

Adverse events were rare in the UPGRADE trial. Diarrhea was reported by 0.9% of people taking ursodiol and 0.4% taking placebo, and skin rash by about 0.5% in each group. No serious adverse event was attributed to the drug. Call the office if you cannot tolerate it instead of quietly stopping.

I already had my gallbladder removed. Does any of this apply to me?

Mostly no. Without a gallbladder you cannot have a gallbladder attack, and ursodiol for prevention is not needed. Rarely, a stone forms or is left in the bile duct itself and causes pain, jaundice or fever. Those symptoms need urgent assessment whether or not you still have a gallbladder.

Talk with Dr. Davtyan in Rancho Cucamonga

Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, is a bariatric surgeon at Davtyan Medical Weight Loss & Wellness, 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730. Call 909-355-2525 or toll free 877-9-BE-SLIM (877-923-7546), or write through the contact page. The first consultation is complimentary, and Hablamos Español. Related reading: the Rancho Cucamonga gastric sleeve guide, gastric sleeve risks and the recovery timeline.

Gallstones After Gastric Sleeve Surgery

Gallstones After Gastric Sleeve Surgery

Why rapid weight loss causes gallstones

How often it happens after a sleeve

Symptoms of a gallbladder attack

Prevention

Ursodiol

What you can do

Treatment if stones cause symptoms

When to call

Go to an emergency room or call 911 if

Call the office if

Frequently asked questions

Should my gallbladder be removed at the same time as my sleeve?

When is the risk of gallstones highest after a sleeve?

Does ursodiol have side effects?

I already had my gallbladder removed. Does any of this apply to me?

Talk with Dr. Davtyan in Rancho Cucamonga

Sources

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Getting care in Rancho Cucamonga

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