Kia ora koutou
I'm a big fan of gastric bypasses (there will be a series of posts coming where I dive into the decision-making about sleeve versus gastric bypass) but one of the downsides of both bariatric surgery in general and gastric bypasses in particular, is the issue of gallstones.
About 30-40% of people, after having a weight loss operation, will make gallstones. Your liver produces bile to help digest food. When you aren't eating, it gets stored in your gallbladder. After you have surgery, the amount of eating that you are doing goes way down, but your liver doesn't realise this immediately and keeps making the same amount of bile.
The bile then stagnates in your gallbladder, and can crystallise into gallstones. There is then a possibility that those gallstones will then cause problems. This can sometimes be pain, but sometimes the gallstones can block the gallbladder outlet and cause the gallbladder to be infected (cholecystitis), migrate out of the gallbladder blocking the bile ducts causing them to be infected (cholangitis) or even blocking the duct from the pancreas and inflaming it (pancreatitis).
There is a straightfoward solution to this: take a medication that gets rid of the extra bile. This is routinely done in my practice, and overseas, and has the highest level of scientific evidence available for it. The treatment consists of taking one tablet, twice a day, for 6 months. Over that time period, your volume of eating is increasing, and your liver is slowly realising what is going on. By 6 months, you are back to the baseline risk of gallstone formation that you had before the surgery.
The medication is well tolerated; about 1-2% of patients will stop taking it because of itchy skin, getting diarrhoea, or getting abdominal pain from the medication. It costs about $200 in total to complete the course of 250mg tablets twice per day, because the medication isn't fully funded by the Government (they pay about 90% of the cost though).
The benefit is fairly massive though. If you make gallstones, and then get problems with them, the only treatment at that stage is to have your gallbladder removed. Preventing the disease before it happens just makes sense. The treatment is highly effective too - it reduces the risk by about 85% which is one of the highest treatment effects I've ever seen. In one study, the number of patients needing their gallbladders removed dropped by a factor of 10.
What really puzzles me is why I am the only bariatric surgeon in New Zealand who is offering this treatment. It does take a bit more of my time - explaining the treatment, providing the prescriptions, but the benefits are signficant. I have given it to over 500 patients now and see far fewer gallstone related issues amongst my patients than I would expect, given the numbers involved.
If you are having surgery with me, you will be offered this. If you aren't, make sure you ask your surgeon (or at least your General Practitioner) to provide this. It's worth it.