What are the physical effects of cholecystectomy and gallbladder removal? Recently, during my online consultations or telephone consultations, I often have patients with gallstones and gallbladder polyps asking if gallbladder removal has any health effects. Usually doctors do not elaborate or cannot clarify in depth to patients in a short time. To put it simply, gallbladder removal has been used clinically for more than 120 years and in general does not have a significant impact on the body; otherwise, the procedure would have been abolished long ago. However, the removal of an organ that the body is supposed to have certainly does not have no effect on the body at all. More than a hundred years of medical records and research have revealed the many disadvantages of removing the gallbladder. Nowadays, the function of the gallbladder and the effects on the body after removal are getting more and more attention, thus proposing that the 21st century is the era of gallbladder cutting and gallbladder preservation side by side. Therefore, I feel that although this issue is extremely specialized, I think patients suffering from gallstones or gall polyps, or those who have already had their gallbladders removed, they still have a desire to understand, so I am writing this article. For their reference. (The following is a diagram and section of the gallbladder adjacent to the surrounding organs The side injuries of cholecystectomy itself and the near and long-term side effects after removal of the gallbladder can include the following: a The side injuries of cholecystectomy: It is well known that during the surgical procedure of cholecystectomy, due to the anatomical complexity of Calot’s triangle and the adhesions of the local tissues There is always a certain probability (bile duct injury: 0.18-2.3%) and a certain mortality rate (0.17%), including: bile duct injury, hepatic duct injury, vascular injury, gastrointestinal injury, etc. It is especially worth emphasizing that the majority of cases of bile duct injury are caused by cholecystectomy. The United States each year to do gallbladder removal about 500,000 cases, so the United States will have thousands of cases of bile duct injury occur each year. China’s population is large, gallbladder stone cases should be above the United States. Domestic Huang Xiaoqiang statistics 2566 cases of CBD (common bile duct) injury, 1933 cases caused by cholecystectomy, accounting for 75% of stenosis cases. Complications of bile duct injury are a very difficult topic in biliary surgery, compared with endoscopic “bile stone extraction” surgery, which is performed in the cavity of the gallbladder, and it is impossible to injure the organs around the gallbladder. This is the biggest drawback of cholecystectomy. Considering the physiological deficiencies and the effects of cholecystectomy, the hasty choice of cholecystectomy should be carefully considered. (Below is a diagram of the anatomical variation of the gallbladder duct and gallbladder artery within Calot’s triangle and a photograph of a medically induced biliary tract injury.) 2. Liver damage and colonic damage: It has been shown that lithotriptanic acid is toxic to hepatocytes. The increase of secondary bile acids after gallbladder resection will cause chronic liver damage and colon damage after the stone bile acids enter the liver and colon through hepatic and intestinal circulation, and colon damage is likely to be a cause of colon cancer. The effects on the body after removal of gallbladder: 1 indigestion, bloating and diarrhea: besides the functions of storage, concentration and contraction, gallbladder also has complex chemical and immune functions. Bile is secreted by liver cells. Liver cells secrete about 800~1200ml of bile every day, of which water accounts for 97%. The bile secreted by hepatocytes is stored and concentrated in the gallbladder along the bile ducts inside and outside the liver. The concentrated bile is 30 times more concentrated than the bile secreted by the liver and is stored in the gallbladder. After eating, especially high-fat food, the gallbladder contracts under the regulation of the vagus nerve and cholecystokinin and expels bile into the duodenal lumen to participate in digestion. If the gallbladder is removed, the bile is secreted by the liver cells and discharged but there is nowhere to store it, so whether the body needs it or not, the bile has to be continuously discharged into the intestine. Humans are mammals that eat intensively, and we need a lot of bile in high concentration to help digestion when we eat, but there is no “surplus bile” in our body to help, thus affecting the digestion and absorption of food, especially the digestion and absorption of fat, which results in steatorrhea and fat-soluble vitamin deficiency; resulting in indigestion, bloating, diarrhea, and wasting. 2 Alkaline reflux gastritis and esophagitis: In normal people, the contraction of the gallbladder after eating causes bile to enter the intestine in large quantities. This process is regularly synchronized with the secretion and peristalsis of the gastroduodenum. After cholecystectomy, the loss of bile reserve function causes bile to be excreted into the duodenum continuously instead of intermittently in connection with eating, and the chance of reflux into the stomach increases, leading to bile reflux gastritis and esophagitis.3 Increased incidence of common bile duct stones after cholecystectomy: In the treatment of common bile duct stones, it can be found that the incidence of bile duct stones is significantly higher in the group with cholecystectomy than in the group without cholecystectomy group. Although gallbladder stones are removed after removal of the gallbladder, there is a high risk of “inviting” common bile duct stones as a result. It is commonly believed that without a gallbladder, stones have nowhere to grow and have to live in the bile ducts. In fact, the causes of gallbladder stones are different from those of bile duct stones. However, the presence of the gallbladder directly affects the formation of bile duct stones. This is because before gallbladder removal, the gallbladder has the function of concentrating bile, and the concentrated bile is more soluble in cholesterol, while after gallbladder removal, bile acid salts are obviously reduced, and the concentration of bile acid in the hepatic bile ducts is reduced, which leads to a lower solubility of cholesterol. In terms of the principle of “fluid mechanics”, the fluid pressure in the bile ducts loses its buffering effect after gallbladder removal, resulting in the increase of pressure in the common bile ducts, which causes compensatory dilation of the common bile ducts, thus making the bile flow in the common bile ducts become slow and vortex or eddy flow occurs. 4 The incidence of postoperative colon cancer may be increased: In recent years, many European scholars have found that among the cases of colon cancer, many of them have a history of gallbladder removal. It has been pointed out that “the risk of colon cancer after cholecystectomy is 45 times higher than that of cases without cholecystectomy”. Animal studies have also shown that secondary bile acids directly increase the incidence of colon cancer in animals. Control studies have found that cholecystectomy increases the proliferative activity of the intestinal mucosa, thereby contributing to the development of carcinoma. It is the qualitative and quantitative alteration of bile after gallbladder removal that is the main cause of colorectal carcinogenesis. The bile acids secreted from the liver are primary bile acids, which enter the intestine and come into contact with bacteria, and become increased in the amount of secondary bile acids. After cholecystectomy, the gallbladder loses its function and primary bile acids flow continuously into the intestine and come into contact with bacteria 24 hours a day, thus producing a large amount of secondary bile acids. The concentration of secondary bile acids in the ascending colon is significantly higher, so the cancer after cholecystectomy is more likely to occur in the right hemicolectomy. Therefore, it is generally believed that the mechanism of promoting colon cancer after cholecystectomy is that more bile circulation after cholecystectomy affects bacterial degradation, resulting in higher content and proportion of secondary bile acids in bile salts, which have carcinogenic or synergistic effects. Therefore, colon cancer is likely to occur.5 Post-cholecystectomy syndrome: The term “post-cholecystectomy syndrome” is a vague concept. With the advancement of modern diagnostic imaging technology, the diagnosis of post-cholecystectomy residual stones and bile duct injury has been excluded. Modern post-cholecystectomy syndrome refers only to the inflammation and dyskinesia of Oddi’s sphincter that occurs after cholecystectomy. Studies have shown that the gallbladder plays a pivotal role in biliary system dynamics, holding 30-60 cc of bile, buffering fluid pressure in the bile duct and maintaining the physiological balance of bile duct pressure. Once the gallbladder is removed, this pressure-regulating equilibrium is disrupted, resulting in Oddi’s sphincter dysfunction. This syndrome is very difficult to treat clinically. The above mentioned consequences of gallbladder removal cannot be explained in detail by doctors before surgery, and they are only indicated by “various complications may occur” in the consent form for surgery, and in case of serious complications such as biliary tract injury, doctors mostly explain them by the complexity of the condition and irresistible, so it is difficult to evaluate medical errors. When you have gallbladder stones or gallbladder polyps, you consult some doctors, but they all say that the removal of the gallbladder does not have much effect on people, and when asked whether it is possible to preserve bile, if the patient mentions bile preservation, they all say in the same voice with disdain: “It will come back after bile preservation, it is a surgery that was abandoned more than a hundred years ago, and it is still being done now, it is really incredible! ” . The majority of gallbladder function is normal in patients with gallbladder polyps. Removing the gallbladder easily for a small benign polyp and losing the gallbladder function invites all kinds of maladies after cholecystectomy, which is a big taboo in modern surgery and should be done with caution. Regarding the treatment of gallbladder polyps, there is a world of difference between biliary preservation and cholecystectomy. Endoscopic biliary polypectomy preserves the physiological function of the gallbladder, while biliary polypectomy loses the gallbladder and its physiological function, which can cause a series of physiological disorders and even the possibility of colon cancer. Gallbladder polypectomy is a very safe procedure, and it is impossible to have those comorbidities of gallbladder removal. After removal of the gallbladder, of course, there is no possibility of recurrence of gallbladder polyps, but there is a risk of increased incidence of common bile duct stones. But which one is more cost-effective? With the development of modern medical science and technology, there is a better understanding of the gallbladder as an important digestive organ: in addition to its role in concentrating, contracting and regulating the pressure of the biliary tract, it is also a complex organ with chemical and immunological functions. The gallbladder is not dispensable. Rather, it is a very important digestive organ and therefore should not be easily abolished! Of course, in cases of gallbladder atrophy, non-functional gallbladder or suspected cancerous gallbladder, the gallbladder should undoubtedly be removed to remove the lesion. In summary, we conclude that, in view of the many disadvantages of gallbladder removal, the practice of removing the gallbladder for benign diseases, regardless of function, is no longer appropriate under current conditions. We hope that doctors and patients will think twice before considering cholecystectomy.