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Gallstones common after weight-loss surgery

What causes gallstones?

Gallstones form when bile — a substance that helps break up fat — contains too much cholesterol. Bile is produced by the liver and stored in the gallbladder until it is needed. Fat in the small intestine triggers the gallbladder to contract and empty, releasing bile into the bile ducts. If the bile contains more cholesterol than the bile salts can dissolve, or if the gallbladder does not properly contract and empty, the bile can crystallize, forming stones. Gallstones can be as small as large as a golf ball or as small as a grain of sand.

Symptoms of gallstones

Many people who have gallstones don't even realize it. Symptoms appear only when the gallstones move into the bile ducts and create blockage, causing a gallbladder attack. The main symptom is pain in the upper abdomen that increases rapidly and can last for several hours. Nausea and vomiting may also occur.

Risk factors for gallstones

Women are at a greater risk for gallstones than men because female sex hormones — estrogen and progesterone — can increase cholesterol levels in bile and slow down the movement of the gallbladder. Hormone replacement therapy and oral contraceptives can increase the risk of gallstones.

Obesity is also a risk factor, possibly due to increased estrogen and cholesterol levels.

The risk of gallstones increases after weight-loss surgery because low-calorie diets interfere with bile production. The risk is the same regardless if you undergo a restrictive procedure like the Lap-Band, or a malabsorptive procedure such as gastric bypass.

Some surgeons recommend removing the gallbladder at the time of the weight-loss surgery as a preventive measure. Many weight-loss surgery patients eventually require a second procedure to remove the gallbladder.

Treatment

The most effective treatment for gallstones is gallbladder removal, which can be performed laparoscopically. Removing the gallbladder does not affect digestion: bile passes directly from the liver into the small intestine.

To prevent gallstones after surgery, some doctors may prescribe an oral medication called ursodiol (Actigall), which is a naturally occurring bile acid that can help dissolve bile stones. Ursodiol may be recommended for three to six months following surgery.

A well-balanced diet and regular exercise may help reduce the risk of gallstones.

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