The gallbladder is a small, pear-shaped organ that sits under the liver on the right side of the abdomen. Its main function is to store and concentrate bile, a digestive fluid produced by the liver. Bile helps break down fats in food as it passes through the small intestine. When food containing fat enters the small intestine, the gallbladder contracts and releases bile to aid in digestion.
Sometimes, gallstones can form inside the gallbladder. Gallstones are solid crystals that develop from bile cholesterol and bilirubin. They can be as small as a grain of sand or as large as a golf ball. Gallstones don’t always cause problems or require treatment. But if they become lodged in the gallbladder ducts or the bile ducts, they can cause symptoms like pain in the upper right abdomen, nausea, vomiting, fever, chills, and jaundice.
If gallstones cause significant symptoms, the usual treatment is surgical removal of the gallbladder, called cholecystectomy. This eliminates the organ that stores the stones and allows bile to flow directly from the liver into the small intestine. However, some people want to avoid gallbladder removal surgery due to the risks and recovery time involved. The question is, can you live without a gallbladder if you have symptomatic gallstones?
What are the risks of gallbladder surgery?
Gallbladder removal is one of the most common surgeries performed today. It’s considered a safe procedure, but like any operation, it does carry some risks:
- Bleeding – Damage to blood vessels may lead to internal bleeding.
- Infection – Surgery creates an opening for bacteria to enter the abdomen.
- Injury to other organs – The intestines, liver, or bile ducts may be inadvertently damaged.
- Blood clots – Clots can form in the veins of the legs after surgery.
- Anesthesia problems – Reactions to anesthesia medications.
- Bile leakage – Bile may leak from ducts left open after gallbladder removal.
Most people recover from laparoscopic cholecystectomy (minimally invasive keyhole surgery) within 1-2 weeks. But for some, pain or digestive troubles linger for months after the operation. Though rare, serious complications like bile duct injuries can have long-lasting effects.
What happens when you don’t have a gallbladder?
The gallbladder’s main purpose is to store and concentrate bile. Without it, bile drips continuously from the liver into the small intestine. This has some implications:
- Since bile isn’t stored and concentrated anymore, it’s always dilute versus reaching higher concentrations during meals. Weakened bile may not digest fat as effectively.
- Without a storage reservoir, bile release can’t be controlled. Bile flows into the intestine when you don’t need it, like between meals.
- Unabsorbed fats and bile acids entering the colon can cause diarrhea for some people, especially after fatty meals.
Most people adjust without difficulty. But 10-15% may deal with ongoing diarrhea, nausea, bloating, pain, or fatty food intolerance after gallbladder removal. This is known as postcholecystectomy syndrome (PCS). For those with severe PCS symptoms, losing the gallbladder can negatively impact quality of life.
What are alternatives to gallbladder surgery?
If you want to keep your gallbladder, you may wonder what options exist besides surgery. It’s important to know that gallstones often don’t require treatment unless they cause problems. Mild pain may be managed with rest and pain relievers. Stones may be observed and surgery considered later if symptoms worsen.
When gallstones do cause significant symptoms, these nonsurgical techniques may be attempted:
Medications
Oral dissolution therapy uses medications like ursodiol (Actigall) to try slowly dissolving cholesterol stones. This has a low success rate and stones often recur after stopping the drug. Pain and anti-nausea medications may provide temporary relief during gallbladder attacks.
Shock wave lithotripsy
This noninvasive procedure uses high-energy sound waves to break larger stones into smaller fragments that can pass through bile ducts. Additional medications may then be used to help clear stone debris. Lithotripsy has not proven very effective for gallstones.
Endoscopic retrograde cholangiopancreatography (ERCP)
A flexible tube equipped with a camera, called an endoscope, is passed through the mouth into the small intestine. The doctor locates the bile duct opening and may insert instruments to remove stones or install a stent to keep the duct open. ERCP is usually reserved for bile duct stones.
Percutaneous cholecystolithotomy (PCCL)
PCCL involves inserting a thin tube through the abdomen directly into the gallbladder. Instruments can then fragment and suction out stones. The tube is removed after the procedure. PCCL may be an option for high-risk patients unfit for surgery.
Lifestyle changes to manage gallstone symptoms
Along with or instead of interventional treatments above, making certain diet and lifestyle adjustments may help you manage gallstone symptoms without surgery:
Low-fat diet
Avoiding fatty and greasy foods that tend to trigger gallbladder attacks and related pain or nausea. Focus on lean proteins, fruits, vegetables, whole grains, and low-fat dairy.
Small, frequent meals
Eating smaller portions spaced regularly throughout the day keeps a steadier flow of bile moving compared to large, heavy meals. Grazing helps prevent the gallbladder from overfilling.
Maintain a healthy weight
Obesity is a major risk factor for gallstones. Losing excess weight reduces cholesterol production and gallstone formation.
Stay active
Regular exercise helps with weight management and may also decrease gallstone risk.
Supplements
Vitamin C, lecithin, and milk thistle may support gallbladder function, improve bile flow, and help manage symptoms. Talk to your doctor before starting any new supplements.
When is gallbladder surgery necessary?
For moderate to severe gallbladder symptoms, surgery may still be required even after trying other options. Removal is definitely indicated if you have:
- Repeated gallstone attacks with vomiting, fever, chills, or jaundice
- Gallstones blocking the pancreatic or common bile ducts
- Gallbladder inflammation or infection (cholecystitis)
- Gallbladder swelling or dysfunction
- Gallbladder cancer
Signs the gallbladder may need to come out include:
- Inability to manage daily activities due to attacks
- Frequent gallstone attacks that don’t respond to other treatments
- Persistent pain between or after attacks
- Nausea, vomiting, fever that recurs
- Jaundice or pancreatitis from a blocked bile duct
Surgery should not be delayed in these situations, as the risks from gallstones usually outweigh surgery risks.
Living without a gallbladder – is it possible?
For the majority of people with troublesome gallstone symptoms, gallbladder removal surgery provides immediate and permanent relief. Quick recovery after laparoscopic surgery also makes it an attractive option.
However, up to 15% of postcholecystectomy patients report ongoing digestive problems that negatively impact their quality of life. Diarrhea, gas, bloating, indigestion, and abdominal discomfort are common complaints. Dietary fat intolerance can also develop after losing the gallbladder.
Some people do manage to live reasonably well with gallstones when:
- Symptoms are mild and tolerable
- Pain and digestive flareups occur infrequently
- A very low-fat diet and lifestyle changes control symptoms
- Alternative treatments provide adequate relief
But for those with severe, frequent gallstone attacks, surgery often becomes necessary eventually. Living without a gallbladder is certainly possible, but it may require significant diet and lifestyle adjustments.
Conclusion
Having your gallbladder removed is still the standard treatment for symptomatic gallstones. While generally safe, cholecystectomy carries some risks like infection, bleeding, bile leaks, and even damage to surrounding organs. A small proportion of patients also develop ongoing digestive side effects after surgery called PCS.
Some alternatives to gallbladder removal may be attempted first, like medications to dissolve stones, clearance procedures like ERCP, or extracorporeal shock wave lithotripsy. With mild symptoms, carefully managing your diet, maintaining a healthy weight, and using supplements can potentially help you manage life with gallstones.
However, if attacks persist and you experience severe pain, nausea, fever, jaundice, or other concerning symptoms, gallbladder removal may become necessary. For most people with symptomatic gallstones, living without a gallbladder – either by choice or out of necessity – requires making major adjustments to prevent post-surgery digestive troubles. But it can certainly be done with care and patience.