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Old 06-03-2008, 09:50 PM   #1
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Lightbulb Cholecystectomy or not? For people without gallstones

I have had recent digestive disorders, probably caused by chronic cholecystitis. Ultrasound showed no gallstones, although I suspect there may be "sludge", or tiny gallstones present. My GB Ejection Fraction is 7%.

One doctor told me to see a surgeon and have it removed. Another doctor, who I trust more, says the surgery is not necessary, only if the pain is unbearable. I do not suffer from painful gallbladder attacks, but insomnia and stress caused by the digestive disorders.

I was planning to have the gallbladder out, until I read much about the PCS - PostCholecystectomy Syndrome. Apparently many who don't have gallstones still suffer their symptoms, or even worse, after having the gallbladder out. (Cholecystectomy)

Please share your thoughts and experiences, and hopefully help all of us to make an informed decision.

 
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Old 06-04-2008, 08:07 PM   #2
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Re: Cholecystectomy or not? For people without gallstones

I just had my Hida scan today. My EF is 16%. I'm going to get my GB removed. Why keep it? It's not working as it should, and I can't eat anything at this point except for extremely bland foods. If your EF is 7%, that's pretty bad. IMO, I won't be any worse off w/o my GB than if I keep it.

Also, remember that the people with problems are the ones that are going to post on the internet. People that have this surgery (or any other surgery) and do NOT have complications arent' likely to seek out forums like this. If they have no problems, there's no point in posting on forums like this. Those people just move on w/their lives.

I'm taking my chances w/GB removal. It doesn't work anyway, so I figure it can only get better.

Last edited by nikkilewis; 06-04-2008 at 08:08 PM.

 
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Old 06-04-2008, 08:33 PM   #3
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Re: Cholecystectomy or not? For people without gallstones

Just some basic information - the ejection rate will not get better. The gb is damaged and nothing corrects that. It can only get worse, not better. Also, a damaged gb can become inflammed and then infected and can rupture. You definitely do not want to get to that point. So while you may be able to gut it out for a while, in the long run, the only real solution is to have it removed.

Most people have issues afterwards because they jump back into their normal diet too soon after surgery. They leave a bile duct to take the place of the gb. It takes time for it to learn to take over. Ingesting fat overloads it and will keep it from functioning properly. A very low fat diet for several weeks after surgery is the best bet.

Good luck as you move forward.

 
Old 06-05-2008, 03:55 PM   #4
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Re: Cholecystectomy or not? For people without gallstones

Thanks! Yes having it out can certainly remove some concerns. But your body will not be the same after any surgery, even after a relatively simple 3-port laparoscopic cholecystectomy.

Possible sugery (cholecystectomy) side-effects:
PCS - Chronic Diarrhea (20&#37
Biliary Leak - Ducts of Luschka - Biliary Peritonitis (33%)
Abdominal Adhesion - internal damages
Intestinal damage
Infection

Most of those symptoms are rare, but some are real. I am not trying to discourage anyone who needs to have it done. It is often quite necessary. I am trying to balance between the surgery and people who don't have painful gallbladder attacks caused by gallstones.

My gb is not inflammed, and does not hurt either. I just had a CT Scan done, no gallstones and everything else is normal as well. Me and my doctors are still trying to find out what causes my symptoms. (me mostly since the doctors can only offter their profession advice, but having I doing most the diagnostic works and research. They give me "directions" to research with)

I have heard if the ejection efficiency is low, the bile simply passes the gb and into your intestines. In that regard I may have already been suffering from PCS. Just some thoughs.

 
Old 06-05-2008, 04:44 PM   #5
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Re: Cholecystectomy or not? For people without gallstones

Titchou is absolutely right. I resisted the idea of surgery too at first, even though my gallbladder was full of stones, and it was also affecting my liver and pancreas. Turns out, I had my gallbladder removed just in the nick of time. I'm not saying that gb removal is a 'magic bullet', and removal may not stop all of the problems, but once it stops working (whether there are stones or not) there is no way to make it start functioning again, and it can cause so many other health problems the longer you let it go. It's just not worth hanging on to, in my honest opinion, but my situation was slightly different. Those post-surgical complications you mentioned are rare, and should be avoided with a good, experienced surgeon. At the end of the day, you do have to be your own advocate, but you need to demand proper treatment (not just a 'wait and see' approach, which too many doctors are willing to do in my view) whatever that may be.

Last edited by glamkat74; 06-05-2008 at 05:10 PM.

 
Old 06-05-2008, 04:52 PM   #6
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Re: Cholecystectomy or not? For people without gallstones

Alan,

I agree with what your research has found you. I have had cramping on the left side prior to cholecystecomy for years before they did a HIDA determining that my GB was not working at all. I was so relieved they found an answer that I went ahead with the surgery without knowing there is a difference between cholecystectomy with stones and without.

I did not have classic GB symptoms but was told (by my GI, my surgeon and my GP) that I was having referred pain.

4 months following the surgery I had more cramping attacks than ever before and hardly got dressed and left my house. I did not have diarrhea, like in the case of some.. just cramping similar to labor pains. I lost 30lbs within the first month or so and then it slowed down - up to 40 lbs now.

The cramping did become less and less, so I thought maybe my body was having a hard time recovering. 3 months ago I started getting upper left quadrant pain after these cramps. It's a pressure pain and lasts about a week. All goes away and I forget then another attack and more pressure pain.

Because of the lack of caring I received from my doctors I stopped seeing them before the LUQ pain. I had an attack so severe on Saturday that I started seeing them again. I started with my GP who will most likely send me back to the GI. I suspect it's my pancreas becoming inflamed.

So, I wish I researched and weighed the options. If there is a way to alleviate the symptoms without removal I would choose that, especially since there is no pain, inflammation, stones, etc. I'm guessing my GB didn't work for a long time and probably had little to do with my symptoms but it was the answer they had at the time.

Back to square one - $10,000 in medical bills later.

 
Old 06-05-2008, 11:45 PM   #7
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Re: Cholecystectomy or not? For people without gallstones

Quote:
Originally Posted by glamkat74 View Post
At the end of the day, you do have to be your own advocate, but you need to demand proper treatment (not just a 'wait and see' approach, which too many doctors are willing to do in my view) whatever that may be.
Hi! I definitely agreed that you HAVE TO be your own advocate. I find that simply being a "patient" and patiently wait-and-see is simply asking for trouble latter on. Most of the time Doctors just want you to wait for your body to fix it itself, while letting you taking on the risk of not changing your life style for the better. When the symptoms finally get worse you get to see your doc more often, and that seems to be a conflict of interest!

My symptoms went on-and-off for 5 years until I finally told my doctor I "suspect" it is a gallbladder problem, not just stress! It saddens me when I think about the 5 years I had lost to get healthier.

Just recently 3, yes (3) of my doctors recommended me to see the same general surgeon for Cholecystectomy. When I finally met the guy and did some background research myself, I found out he is more of a "weight-loss" gastric type of surgeon, and only performs 4-port cholecystectomy.

I found 3-port cholecystectomy to be comparable to 4-port with less pain/recovery through my research. Needless to say now I am on my own, contacting other general surgeons who does perform a 3-port with newer equipments...

 
Old 06-06-2008, 12:23 AM   #8
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Re: Cholecystectomy or not? For people without gallstones

Quote:
Originally Posted by ZoeGirl View Post
I agree with what your research has found you.
Hi ZoeGirl, I am sorry that your Dr's have not been able to find a cause for your symptoms as well.

In my case, the Dr I trust the most didn't think the GB would affect the pancreas, causing diabetic symptoms. But I read somewhere it is possible. Since then I have been doing a lot of research, hopefully my research methods may help you: (I keep them in Excel sheets)

Keep a detailed diary - weight, blood pressure, bowl movement, food intake, exercise, time of fatigue, symptoms, etc.
Gather possible causes and their info - IBS, IBD, Pancreatitis, Diabetes, Hepatitis, etc.
Compile a table of your symptoms and each diseases' symptoms, and try to eliminate the possible causes.

Do not attempt the research yourself if you maybe a hypochondriac or are not open minded. It may make your symptoms worse! Many more serious diseases may have similar symptoms and you must look at the statistics as well for their low possibilities.

I found ***** and Wiki's to be good resources to start.

It seemed to me to be ridiculous in this day and age, the health system cannot provide some of us adequate care.

Getting old sucks, having health issues sucks, but my much, much older friends would smile and tell me - " IT SURE BEATS THE ALTERNATIVE! " *_^

Last edited by AlanPi; 06-06-2008 at 12:27 AM.

 
Old 06-16-2008, 12:34 PM   #9
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Re: Cholecystectomy or not? For people without gallstones

I found some more info related to PCS - Sphincter of Oddi Dysfunction after Cholecystectomy:
Quote:
SPHINCTER OF ODDI DYSFUNCTION (BILIARY DYSKINESIA: POST-CHOLECYSTECTOMY SYNDROME)

What Is Sphincter of Oddi Dysfunction?

Sphincter of Oddi Dysfunction (SOD) is a symptom complex of intermittent upper abdominal pain that may be accompanied by nausea and vomiting. This disorder is not completely understood. It is thought to be caused by either scarring or spasm of the sphincter of Oddi muscle. The sphincter of Oddi muscle is a small circular muscle approximately ½ inch in length, located at the downstream end of the bile duct and pancreas duct. The function of this muscle is to keep the bile duct and pancreatic duct muscles closed and, therefore, prevent reflux of intestinal contents into the bile duct and pancreas duct. If this muscle should spasm or scar, drainage of the bile duct and/or pancreas duct may be hindered. Abnormal dilation of the bile duct and/or pancreas duct is often associated with an increase in the products and enzymes made by the liver, gallbladder and pancreas, which can be tested for with blood tests (serum liver tests, amylase, lipase). If the ducts are blocked this may result in pain.

Who Gets SOD?

Biliary dyskinesia may develop after the gallbladder has been removed, hence the name post-cholecystectomy syndrome.

What Are the Symptoms of SOD?

Symptoms may be similar to those for which the gallbladder was initially removed and include abdominal pain, nausea and vomiting. The symptoms may be episodic. They may wax and wane. Subjects may experience weight loss due to poor appetite. Fever, chills and diarrhea are not characteristic of this disease. If symptoms are severe and do not respond to conservative treatment, further investigation may be warranted.

What Establishes a Diagnosis of SOD?

It is important to verify that other, more serious conditions are not being missed prior to embarking on a diagnosis of sphincter of Oddi dysfunction. Therefore, it would be important to verify that the patient does not have stones within the bile ducts, cancer of the pancreas or bile ducts, peptic ulcer disease or heart disease (poor blood flow to the heart, called “ischemia” or “angina” may mimic these symptoms).

The diagnosis of sphincter of Oddi dysfunction can be evaluated and confirmed using a special endoscope that allows the placement of a catheter into the bile and pancreatic ducts. Injection of contrast through the catheter coupled with the use of X-rays can give the physician pictures of the bile and pancreatic ducts. The procedure, that requires a special scope is known as an endoscopic retrograde cholangiopancreatography (ERCP). This procedure can help determine the presence of gallstones in the gall bladder or bile duct. In the case of bile duct stones, special instruments and procedures (sphincterotomy with stone extraction) (see figure 2, above) can be used at the time of ERCP to remove the vast majority of them. Measurements of the contracting force of the sphincter of Oddi muscle can be made using a special plastic tube inserted into the bile duct or pancreas duct at the level of the sphincter of Oddi muscle. This is called “sphincter of Oddi manometry” and is used to determine if the muscle is “dyskinetic” or contracts abnormally. If it does, a diagnosis of biliary dyskinesia is confirmed.

What Is the Treatment of SOD?

In patients with severe symptoms that cannot be tolerated, the sphincter muscle may be cut open using the ERCP scope and a special plastic tube with a small wire attached to the side (called a “sphincterotome”). The sphincterotome is passed through the ERCP scope channel, then into the bile duct and/or pancreas duct at the level of the sphincter muscle. A small electric current is then applied to the wire, which then cuts and cauterizes the open muscle. This is called “sphincterotomy”. This procedure should only be done by highly experienced doctors and only when symptoms are severe and do not resolve. Approximately 5-15% of patients who undergo this therapy may develop inflammation of the pancreas (called “pancreatitis”) as a complication immediately following this procedure.

 
Old 07-08-2008, 02:26 PM   #10
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Re: Cholecystectomy or not? For people without gallstones

AlanPi -

I had my GB out laproscopically a month ago. I had been through years of struggling with 'stomach issues' and my gastro sent me to the surgeon to have it out last fall. The surgeon then said he didn't think it was my GB and let's try some meds, are you stressed, etc. UGH! I just got sick of it all and lived through the pain until a couple of months ago when I ended up in the ER. I was worried about all of the post-op things you hear, but you have to remember that a lot of the people post b/c they are having trouble, not b/c they feel better. At least that's when I look at these boards :-)
Anyway, I have not had ANY side effects, save a little diarrhea the first week. I can eat whatever I want, although I have taken it easy on the dairy products and salad. So - research and then go with your gut. No pun intended!

Good luck to you!

p.s. I didn't have stones either, just sludge.

 
Old 07-09-2008, 01:32 AM   #11
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Re: Cholecystectomy or not? For people without gallstones

Quote:
Originally Posted by llovell67 View Post
I didn't have stones either, just sludge.
Thanks! That's what a lot of us should be, stay positive. 90% of the patients do recover well. I also dealt with stomach issues for a while, until the H. Pylori bacteria was removed.

Since I don't know if I even have sludge or not, I am going to try to request for MRCP, or another HIDA, or even just Ultrasound. I will be seeing another GI Doctor for one more opinion, if he/she says remove it, then I will.

I just wish that for the 10% of us who have to suffer, there is a way to tell before cholecystectomy what their chances are... I also feel a little uncomfortable having this surgery in my 30's, since the common bile duct grows with age...

Cheers!

 
Old 07-09-2008, 10:16 PM   #12
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Re: Cholecystectomy or not? For people without gallstones

I had no sludge or stones. I just had an ejection fraction of 16%, which was enough for me. Heck, I figured that since my GB wasn't working, I may as well have it out. I have to say that today has been a great day. I actually ate about 3/4 of a slice of pepperoni w/extra cheese pizza from Pizza Hut today with NO ill effects. That's like a dream come true for me at this point, lol. Before I got my GB removed, I wouldn't even look at a piece of pizza. At 3 days post-op, I had one tiny slice of a Tombstone pepperoni pizza, and I got the old back pains I would get prior to having my GB removed. It wasn't as severe, but it was enough to get my attention. So, I'm definitely getting better. I don't regret getting my GB removed, and would do it all over again.

 
Old 07-09-2008, 10:47 PM   #13
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Re: Cholecystectomy or not? For people without gallstones

Hello -

I am scheduled to have my gall bladder out on July 17. No stones, just non-functioning with a 14% rate. I am kinda scared, but I know I have to do it. I have a constant dull ache on upper r - w/ contractions. It feels like it's twisting sometimes.

I hope after the surgery I get some energy back. I am dead-tired by 5:30 pm. Can barely make myself do anything. Anything I eat makes me feels like i have to go all day.

Surely I will feel better after the surgery...?
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Last edited by Sadlyn; 07-09-2008 at 10:54 PM. Reason: Had wrong surgery date!!

 
Old 07-09-2008, 11:37 PM   #14
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Re: Cholecystectomy or not? For people without gallstones

Quote:
nikkilewis
That is great to hear! I am glad you are already feeling better! Just got to take it easy.

Right now I have some diabetic symptoms to fight with. The gallbladder doesn't seem to be as much of an issue at this point. I will probably still have it out once I found out if it is diabetes related or not (gallbladder paresis?).

Cheers!

 
Old 07-09-2008, 11:42 PM   #15
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Re: Cholecystectomy or not? For people without gallstones

Quote:
Originally Posted by Sadlyn View Post
I am scheduled to have my gall bladder out on July 17. No stones, just non-functioning with a 14% rate. I am kinda scared, but I know I have to do it. I have a constant dull ache on upper r - w/ contractions. It feels like it's twisting sometimes.

I hope after the surgery I get some energy back. I am dead-tired by 5:30 pm. Can barely make myself do anything.
I have no stones also just 7% function. I have similar symptoms as yours. For now, taking Centrum seems to be consistent for me to combat the fatigue. I take 1/2 Centrum at lunch, then again at dinner. Hope that helps until you get your surgery. Good luck!

 
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