Should your gallbladder ever be removed?

[Kradmelder]

Kradmelder,
Well earlier they said his gallbladder is infected and not in good shape. See above in an earlier post. But they claim infected gallbladders are incurable. However alternative doctors like mercola say that gallbladders are curable with nutrition. Who do you believe?

I would believe the specialist old white man i am quite wary of quackery but doctors take educated guesses. The first diagnosis has the least info. Each doctor after has a bit more. it seems like last test results indicate all is ok so an infection isn't the problem. So I believe waiting is best.

[Winston]

My dads response to some articles I sent him about why the gallbladder is necessary and not vestigial, as medical doctors are taught to believe.

Dad:

"Thank you, lots of good information. I read twice to digest. It explains in detail the functionality of gallbladder. The gallbladder tries to do its job to solve the problem passing from liver and receives the blames. When it was removed, then the problems pass on to next victim pancreas. This all makes sense in real life. From this information, we should watch what we put through our mouth because our organs have to deal with.

My problem is my gallbladder is already damaged and could not be cured once it is bad. Is there information to reverse the damaged gallbladder?"

[Rock]

My dads response to some articles I sent him about why the gallbladder is necessary and not vestigial, as medical doctors are taught to believe.

Dad:

"Thank you, lots of good information. I read twice to digest. It explains in detail the functionality of gallbladder. The gallbladder tries to do its job to solve the problem passing from liver and receives the blames. When it was removed, then the problems pass on to next victim pancreas. This all makes sense in real life. From this information, we should watch what we put through our mouth because our organs have to deal with.

My problem is my gallbladder is already damaged and could not be cured once it is bad. Is there information to reverse the damaged gallbladder?"

Winston, if you want, I can put your dad in touch with director of Gallbladder division in the Dongguan hospital I had my surgery at. They are real experts on everything to do with gallbladder and if your dad explained the specific diagnosis from Taiwan doctors there, the director could perhaps order a couple more tests to be done in Taiwan and or straight up determine his best course of action.

The doctors there including director are actually open to answering potential patient queries over telephone I believe.

[Winston]

Sure that would be great rock. Would my dad have to call them, or could he just email them? My dad doesnt trust anything from china. His biases run too deep. Maybe you can call him and recommend it?

[HouseMD]

So, here's the deal with gallbladders.

Gallbladders that are symptomatic have stones in them. These stones vary in size and number. If they're big enough, they actually are less likely to be a serious problem. Small ones, however, are extremely likely to lodge in the common bile duct or cystic duct. Once blocked, there is no longer a regular flow of bile to keep bacteria out of the common bile duct, so you end up with infection of the duct, which can spread into your pancreas, liver, or gallbladder. This infection can be serious, and even fatal. Even in the absence of infection, a stone.can cause blockage of pancreatic enzyme flow, causing your pancreatic enzymes to back up into the pancreas, resulting in pancreatitis as the enzymes digest the pancreas instead of your food.

We know that, statistically, basically 100% of people with stones of a certain size and number will end up with another bout of either pancreatitis or cholangitis. Even if you break up the stones, the majority of people will have recurrence within 2 years. Pancreatitis, cholangitis, and necrotizing cholangitis can all be fatal. And we're talking up to a 3 in 10 or higher chamce of death for an elderly person with a necrotic gallbladder.

So what purpose does the gallbladder serve? It helps you store bile, which serves as a detergent to break up fats for absorption. Our modern diets are much higher in fats and cholesterol than we evolved to handle, and most gallbladder issues occur after reproductive age do they were not naturally selected out. Now, without a gallbladder, you're liver basically kicks up bile production and your common bile duct dilates to show for increased flow. Most people are fine after removal. Some have persistent digestive issues in regard to fatty meals.

The procedure itself is very safe. I've seen zero patients die from complications of gallbladder removal. I've seen dozens of patients die from pancreatitis and nectotic gallbladders over the years. It's a pretty cut and dry thing, really. The only time I'm iffy about having a gallbladder removed is if a person already has gastroparesis or dietary restrictions that might make a low fat diet difficult, or if their stones are secondary to an abrupt weight loss and thus are likely to not recur if we dissolve them.

So that's gallbladders I guess.

[Shemp]

Our modern diets are much higher in fats and cholesterol than we evolved to handle

Sez the same guy who recommends high fat diets.

[HouseMD]

Our modern diets are much higher in fats and cholesterol than we evolved to handle

Sez the same guy who recommends high fat diets.

They're fine if you're not overweight, and I specifically recommended a high-protein, low carb diet with the balance of calories made up by fat. It'll cut weight better than anything.

[HouseMD]

Our modern diets are much higher in fats and cholesterol than we evolved to handle

Sez the same guy who recommends high fat diets.

They're fine if you're not overweight, and I specifically recommended a high-protein, low carb diet with the balance of calories made up by fat. It'll cut weight better than anything.

I should probably add a post-script as to why this is. High body fat increased levels of estrogen, as fat cells have their own estrogen creating aromatases. Estrogen is in large part to do with the reason gallstones develop due to its effects on biliary function and bile production. That's why the prototypical patient with gallbladder issues is fat, fertile, female, and 40- that's a peak estrogen patient. So if you're thin, high day and cholesterol don't cause gallbladder problems as a man, but can if you're a multiparous female (though it's less likely than a fatty by a SUBSTANTIAL amount).

[Kradmelder]

Our modern diets are much higher in fats and cholesterol than we evolved to handle

Sez the same guy who recommends high fat diets.

They're fine if you're not overweight, and I specifically recommended a high-protein, low carb diet with the balance of calories made up by fat. It'll cut weight better than anything.

That is the banting diet here recommended by that saffer sports doctor Tim noakes.

Seems to have spread world wide. High fat high meat no carbs or fruit.
https://en.m.wikipedia.org/wiki/Tim_Noakes
It is very popular here but it seems like another fad diet to me. Common sense and thermodynamics tells you that if you consume more calories than you burn you will get fat. Sugars and carbs are easy calories. I'm not fat and lovery fresh bread and potatoes. I eat meat every meal. But i drink no cool drinks, except with brandy and little sugar. I don't need any diet like some feedlot heifer.

[HouseMD]

I've been doing some research and most sites say that removing the gallbladder is ok and that most people have no problem with having theirs removed. However, this article is an exception and so is sort of a maverick article. What do you think? Does it make sense? I'm not a doctor, so I can't say, but even if I was, I would be biased by my "education" and my knowledge would depend on the sources I read. Who's to say that only authoritative government sources can be trusted?

https://jonbarron.org/article/healing-l ... allbladder

Gallstones and the biliary system

As we discussed last issue, gallstones don't start in the gallbladder; they are related to cholesterol metabolic defects originating in the liver itself. They also happen to be associated with obesity and pregnancy. Essentially, if the cholesterol produced in your liver is too thick and becomes too concentrated in the bile and sits too long in the gallbladder, it can crystallize and form gallstones. It is estimated gallstones result in some 600,000 hospitalizations and more than 500,000 operations each year in the United States alone. Bottom line: it's one of the most prevalent digestive disorders known.

The usual treatment is laparoscopic surgery to remove the gallbladder. The surgery itself has now become so routine that it can be completed in about an hour and the patient leaves the same day -- back to work the next day.

However, because it does not address the underlying cause of the problem (metabolic issues in the liver), gallbladder surgery often does not resolve the patient's discomfort. And because it eliminates the body's regulating mechanism for the release of bile when needed, it often creates new digestive problems of its own. In fact, after gallbladder removal, some 13% of patients report persistent pain. Another 17% report chronic diarrhea, and another 20% report intermittent digestive problems and pain. The bottom line is that although surgeons will report an almost 100% success rate for the surgery, patients will report a 50 % failure rate. It's all a matter of perspective. The surgeon considers the surgery successful if the patient survives, there are no immediate problems, and she collects her fee without a lawsuit. The patient, unfortunately, has to live with the long term results.

The biliary tree
The biliary tree is the anatomical term for the treelike path by which bile is secreted from the liver on its way to the duodenum.



It is referred to as a tree because it begins with a multitude of small branches coming from the thousands of liver lobules which empty into the common bile duct, which is sometimes referred to as the trunk of the biliary tree. Hanging off the trunk, tucked up into the liver is the gallbladder. It is a secondary outpouching, if you will -- an outpouching of the bile duct coming from the liver, which is itself an outpouching of the digestive tract. The gallbladder lies in a groove under the liver, between the two lobes, and is a soft, thin-walled sac, shaped like a fat carrot, with its narrow end pointing toward the bile ducts.

Liver duct system
Bile drains from the ultra small bile ducts (ductiles) that service each of the liver's tens of thousands of lobules into progressively larger ducts, culminating in the common bile duct. The right and left hepatic ducts join just outside the liver to form the common hepatic duct.

Bile passing through the common bile duct exits and enters the gallbladder through the cystic duct. Most physicians refer to the gallbladder as a vestigial organ (as they do the appendix) -- meaning that it's lost most of its original function and now pretty much "gets in the way." To them, this explains why the gallbladder does not usually empty completely, which allows gallstones to form -- leading to pain, infection, inflammation, and even cancer. This also explains why they remove upwards of half a million gallbladders a year in the United States alone.

They are wrong!

The gallbladder serves a definite function. It is not vestigial. It regulates the flow of bile so that it can "push out" into the digestive tract in bursts as needed to assist in the digestion of fats. In fact, the gallbladder will contract to squeeze out stored bile when stimulated by a fatty meal. Without the gallbladder, bile merely dribbles out in a constant flow, thus being present when not required and insufficiently present when needed. This can lead to a whole series of digestive problems including poor digestion, intestinal distress, diarrhea, and an inability to fully break down fats. In fact, many people, as they age, need to take an ox bile supplement (available at all health food stores) with their meals to compensate for insufficient bile in their digestive tracts. If you have digestive problems after eating fatty meals, it's one of the first things you (and your doctor) should look at.

It is important to understand that problems with the gallbladder rarely stem from the gallbladder itself. They stem from the liver, which if not functioning properly will manufacture bile that is prone to "stoning." Thus removing the gallbladder does not eliminate the problem; it merely eliminates ONE place problems can manifest. Where else can problems manifest? If you follow the biliary tree down past the gallbladder, you will find that the common bile duct joins the pancreatic duct before entering the duodenum through the ampulla of Vater. And there's the problem. Although stones and sludge formed in the liver can no longer get trapped in the gallbladder (if it's been removed), they can still quite easily get lodged in the pancreatic duct and ampulla of Vater. This causes the digestive juices secreted by the pancreas to back up into the pancreas itself and start inflaming and digesting pancreatic tissue. This is called pancreatitis.

In other words, by merely removing the gallbladder and not addressing the underlying problem of "bad bile" being formed in the liver, you may potentially merely be moving symptoms from the gallbladder to the pancreas. Fortunately, there are alternatives. Dietary changes will often help. But the best way to optimize the health of your liver, gallbladder, and pancreas is to regularly cleanse and flush the liver and gallbladder.

So here's the deal- you have a 1% chance per year of having serious complications from your gallstones that require operative intervention. This is what is called a natural history of the disease, and what it amounts to is that if you develop gallstones at 35 and plan to live another 40 years, there is a 40% chance that you will end up with a serious complication. These range from plain old choledocholithiasis, mortality rate 1%, morbidity 10%, to cholangitis, which has a mortality rate of up to 88%. Cholangitis, by the way, is what happens should normal gut flora manage to get into your gall bladder, which they promptly start to devour due to the ample nutrients and static environment. Suggesting probiotics for that is downright criminal, but not surprising for Mercola- his articles always boil down to "buy my stuff, but it forever! Probiotics, enzymes, fats, and vitamins, you need everything I sell and you need to be on it forever!" A great example of that is his saying that you need to take lipase to balance out your body's fatty acids- despite the fact that he's already trying to sell you fatty acids, upon which loose has no function. What lipase does is convert one molecule with three fats attached to it into a glycerol backbone and three fatty acids- if you're already taking fatty acids, your body doesn't need lipase, that's just stupid.

So that brings me to diet and all that- a good diet, lots of regular exercise, a complete abstinence from alcohol, substantial weight loss, and adequate hydration can help prevent stones, but does absolutely nothing for the ones you already have The body has no mechanism for clearing stones- they are an accidental precipitate from too high of a concentration of bile. There is no enzyme your body possesses that can break down these stones, much like with kidney stones, so the only things they can do are pass or stay. If they stay and are extremely large, they will likely intermittently block the bile duct within the gallbladder, causing intermittent colic for life. If they're small enough to enter the bile duct, they will likely eventually block it, or form sludge (bile sludge is basically a bunch of sand grain sized stones that slow bile flow until infection develops).

So is it possible to remove stones from the gallbladder while keeping it? Yes, there are places that can use sound waves to break up stones, there's a med you can take for a year that will slowly dissolve the stones, and they can be surgically removed. Surgery has a high complication and recurrence rate, so most places won't do it (removal of the gallbladder is both technically easier, has a tenth of the complications, and has minimal postoperative issues), sound disruption of the stones is hard to find and also has a decently high complication rate owing to the stone shards getting lodged in the common bile duct, and the medication works but the vast majority of people who take it have recurrence within five years.

Try everything you want. I knew a guy that was big into the alternative medicine stuff, encouraged him to try every avenue. He cleaned up his diet, took a bunch of supplements, drank all the water, exercised like a fiend, and in the end still ended up with worsening pain and ultimately had it out. Feel free to pursue whatever alternatives you want, not my job to judge, but unless you've lost 100 pounds, consume no alcohol, and have aged to the point that your testosterone has dropped, you're probably not going to have any improvement, and every year you wait puts you at risk for some serious complications.

[Rock]

I've been doing some research and most sites say that removing the gallbladder is ok and that most people have no problem with having theirs removed. However, this article is an exception and so is sort of a maverick article. What do you think? Does it make sense? I'm not a doctor, so I can't say, but even if I was, I would be biased by my "education" and my knowledge would depend on the sources I read. Who's to say that only authoritative government sources can be trusted?

https://jonbarron.org/article/healing-l ... allbladder

Gallstones and the biliary system

As we discussed last issue, gallstones don't start in the gallbladder; they are related to cholesterol metabolic defects originating in the liver itself. They also happen to be associated with obesity and pregnancy. Essentially, if the cholesterol produced in your liver is too thick and becomes too concentrated in the bile and sits too long in the gallbladder, it can crystallize and form gallstones. It is estimated gallstones result in some 600,000 hospitalizations and more than 500,000 operations each year in the United States alone. Bottom line: it's one of the most prevalent digestive disorders known.

The usual treatment is laparoscopic surgery to remove the gallbladder. The surgery itself has now become so routine that it can be completed in about an hour and the patient leaves the same day -- back to work the next day.

However, because it does not address the underlying cause of the problem (metabolic issues in the liver), gallbladder surgery often does not resolve the patient's discomfort. And because it eliminates the body's regulating mechanism for the release of bile when needed, it often creates new digestive problems of its own. In fact, after gallbladder removal, some 13% of patients report persistent pain. Another 17% report chronic diarrhea, and another 20% report intermittent digestive problems and pain. The bottom line is that although surgeons will report an almost 100% success rate for the surgery, patients will report a 50 % failure rate. It's all a matter of perspective. The surgeon considers the surgery successful if the patient survives, there are no immediate problems, and she collects her fee without a lawsuit. The patient, unfortunately, has to live with the long term results.

The biliary tree
The biliary tree is the anatomical term for the treelike path by which bile is secreted from the liver on its way to the duodenum.



It is referred to as a tree because it begins with a multitude of small branches coming from the thousands of liver lobules which empty into the common bile duct, which is sometimes referred to as the trunk of the biliary tree. Hanging off the trunk, tucked up into the liver is the gallbladder. It is a secondary outpouching, if you will -- an outpouching of the bile duct coming from the liver, which is itself an outpouching of the digestive tract. The gallbladder lies in a groove under the liver, between the two lobes, and is a soft, thin-walled sac, shaped like a fat carrot, with its narrow end pointing toward the bile ducts.

Liver duct system
Bile drains from the ultra small bile ducts (ductiles) that service each of the liver's tens of thousands of lobules into progressively larger ducts, culminating in the common bile duct. The right and left hepatic ducts join just outside the liver to form the common hepatic duct.

Bile passing through the common bile duct exits and enters the gallbladder through the cystic duct. Most physicians refer to the gallbladder as a vestigial organ (as they do the appendix) -- meaning that it's lost most of its original function and now pretty much "gets in the way." To them, this explains why the gallbladder does not usually empty completely, which allows gallstones to form -- leading to pain, infection, inflammation, and even cancer. This also explains why they remove upwards of half a million gallbladders a year in the United States alone.

They are wrong!

The gallbladder serves a definite function. It is not vestigial. It regulates the flow of bile so that it can "push out" into the digestive tract in bursts as needed to assist in the digestion of fats. In fact, the gallbladder will contract to squeeze out stored bile when stimulated by a fatty meal. Without the gallbladder, bile merely dribbles out in a constant flow, thus being present when not required and insufficiently present when needed. This can lead to a whole series of digestive problems including poor digestion, intestinal distress, diarrhea, and an inability to fully break down fats. In fact, many people, as they age, need to take an ox bile supplement (available at all health food stores) with their meals to compensate for insufficient bile in their digestive tracts. If you have digestive problems after eating fatty meals, it's one of the first things you (and your doctor) should look at.

It is important to understand that problems with the gallbladder rarely stem from the gallbladder itself. They stem from the liver, which if not functioning properly will manufacture bile that is prone to "stoning." Thus removing the gallbladder does not eliminate the problem; it merely eliminates ONE place problems can manifest. Where else can problems manifest? If you follow the biliary tree down past the gallbladder, you will find that the common bile duct joins the pancreatic duct before entering the duodenum through the ampulla of Vater. And there's the problem. Although stones and sludge formed in the liver can no longer get trapped in the gallbladder (if it's been removed), they can still quite easily get lodged in the pancreatic duct and ampulla of Vater. This causes the digestive juices secreted by the pancreas to back up into the pancreas itself and start inflaming and digesting pancreatic tissue. This is called pancreatitis.

In other words, by merely removing the gallbladder and not addressing the underlying problem of "bad bile" being formed in the liver, you may potentially merely be moving symptoms from the gallbladder to the pancreas. Fortunately, there are alternatives. Dietary changes will often help. But the best way to optimize the health of your liver, gallbladder, and pancreas is to regularly cleanse and flush the liver and gallbladder.

So here's the deal- you have a 1% chance per year of having serious complications from your gallstones that require operative intervention. This is what is called a natural history of the disease, and what it amounts to is that if you develop gallstones at 35 and plan to live another 40 years, there is a 40% chance that you will end up with a serious complication. These range from plain old choledocholithiasis, mortality rate 1%, morbidity 10%, to cholangitis, which has a mortality rate of up to 88%. Cholangitis, by the way, is what happens should normal gut flora manage to get into your gall bladder, which they promptly start to devour due to the ample nutrients and static environment. Suggesting probiotics for that is downright criminal, but not surprising for Mercola- his articles always boil down to "buy my stuff, but it forever! Probiotics, enzymes, fats, and vitamins, you need everything I sell and you need to be on it forever!" A great example of that is his saying that you need to take lipase to balance out your body's fatty acids- despite the fact that he's already trying to sell you fatty acids, upon which loose has no function. What lipase does is convert one molecule with three fats attached to it into a glycerol backbone and three fatty acids- if you're already taking fatty acids, your body doesn't need lipase, that's just stupid.

So that brings me to diet and all that- a good diet, lots of regular exercise, a complete abstinence from alcohol, substantial weight loss, and adequate hydration can help prevent stones, but does absolutely nothing for the ones you already have The body has no mechanism for clearing stones- they are an accidental precipitate from too high of a concentration of bile. There is no enzyme your body possesses that can break down these stones, much like with kidney stones, so the only things they can do are pass or stay. If they stay and are extremely large, they will likely intermittently block the bile duct within the gallbladder, causing intermittent colic for life. If they're small enough to enter the bile duct, they will likely eventually block it, or form sludge (bile sludge is basically a bunch of sand grain sized stones that slow bile flow until infection develops).

So is it possible to remove stones from the gallbladder while keeping it? Yes, there are places that can use sound waves to break up stones, there's a med you can take for a year that will slowly dissolve the stones, and they can be surgically removed. Surgery has a high complication and recurrence rate, so most places won't do it (removal of the gallbladder is both technically easier, has a tenth of the complications, and has minimal postoperative issues), sound disruption of the stones is hard to find and also has a decently high complication rate owing to the stone shards getting lodged in the common bile duct, and the medication works but the vast majority of people who take it have recurrence within five years.

Try everything you want. I knew a guy that was big into the alternative medicine stuff, encouraged him to try every avenue. He cleaned up his diet, took a bunch of supplements, drank all the water, exercised like a fiend, and in the end still ended up with worsening pain and ultimately had it out. Feel free to pursue whatever alternatives you want, not my job to judge, but unless you've lost 100 pounds, consume no alcohol, and have aged to the point that your testosterone has dropped, you're probably not going to have any improvement, and every year you wait puts you at risk for some serious complications.

House, the hospital I went to in China removed 18 stones from my gallbladder, each 0.8 - 1.0 cm in diameter. I had been having painful intermittent attacks for many years ever 2-8 months. Usually I had to go to ER to get treated intravenously with buscopan, strong pain meds, and wait for the muscle spasms to settle down so I would feel relief. This usually took 2-3 hours once I arrived. It felt like someone was thrusting a knife into my rib cage, so painful.

At the nearly 2 year mark, I had a check-up. At that stage, stones had not returned at all and I've felt great even up to now (an additional several months). They gave me some stuff to help prevent them from returning and also suggested dietary changes which would reduce risk. Apple cider vinegar is good too.

All the hospitals and doctors I had visited previously in several other countries all told me there was no way to dissolve such stones through shock waves, substances, etc. My stones were too big and robust. They all just wanted to remove the organ.

This hospital in China has performed 1,000s of successful stone removal cases. Complication rate is extremely low. They also go traditional organ removal route for patients who's gallbladders already have very poor function since removing stones will not restore the damaged organ in these cases. They do have a small percentage of patients who repeat the surgery after many years due to recurrence of stones. But overall, they are doing great work and given their specialist nature, I would say it's a great option for people like me who had stones causing problems but a still well-functioning organ.

[HouseMD]

Hey, I'm not saying stone removal is the worst operation in the world. Most doctors just won't do it because the complication rate is tenfold higher than removing the gallbladder, and, at least in first world countries, doctors really just hate being in court. Over the life of a surgeon, that's a few more trips to the 'ol lawyer nobody wants. Myself, knowing the risks? I'd probably try dissolving the stones or breaking them up, then just go for having the thing out. But hey, that's just me.

Those are some pretty big stones- to give you an idea, the bile duct is about 0.1 cm in diameter, so those stones were never moving. Keep your weight down, lay off the alcohol, drink lots of water, exercise regularly, and eat right and hopefully you'll never have stones again.

[Rock]

Hey, I'm not saying stone removal is the worst operation in the world. Most doctors just won't do it because the complication rate is tenfold higher than removing the gallbladder, and, at least in first world countries, doctors really just hate being in court. Over the life of a surgeon, that's a few more trips to the 'ol lawyer nobody wants. Myself, knowing the risks? I'd probably try dissolving the stones or breaking them up, then just go for having the thing out. But hey, that's just me.

Those are some pretty big stones- to give you an idea, the bile duct is about 0.1 cm in diameter, so those stones were never moving. Keep your weight down, lay off the alcohol, drink lots of water, exercise regularly, and eat right and hopefully you'll never have stones again.

I'm a slim guy who doesn't drink except an occasional wine or social drink and I exercise fairly regularly. I have not idea how I developed such big stones over decades.

Could it be that being focused specialists on something so narrow enables them to reduce the normal complication rate to an acceptable level? I've seen this same dynamic play out with certain pioneers in past. For example, hair transplants used to have high resection rates until a handful of doctors figured out how preserve most transplanted hairs, even with dense packing, and many other doctors over time were trained in same technique. Also, consider fat grafting which used to be temporary (most transplanted fat would die within months due to lack of blood supply) until one or more pioneering doctors figured out how to harvest and transplant in a way that a large percentage of the fat would become virtually permanent. And I don't think many hospitals around the world perform orthognathic surgery for minor cosmetic improvements except for those in S. Korea. Seoul pumps out 10,000s of thousands of these cases every year through their many cometic hospitals and clinics. And they've become the go to place for local women and the masses of Chinese and other E/SE Asians who wanna look better. Many of the doctors there have become expert and creating dramatic improvements by cutting and adjusting bones of the face and jaw. I doubt these patients could achieve these results or even find doctors willing to operate on them most anywhere else in the world.

Perhaps this hospital in China and maybe a few others there are doing pioneering gallbladder work so that with their techniques, complication rate can be reduced to very low (acceptable level). I've found that in different countries, there are dramatically different techniques and skill levels for given procedures. It seems that some doctors and clinics trial and error their way to expertise over 100s to 1,000s of cases over years and decades. That means earlier patients are like guinea pigs and some may suffer. But once the effective and low risk techniques are figured out, future patients benefit. I think Thomas Edison tried out hundreds of substances before he figured out what worked for the lightbulb filament.

[Winston]

Heres what my cousin, an MD in California, told me.

"Agree gallbladder besides being a bag of bile collection that it still has contractile function. So not useless!

But disagree that it is necessary. Without gallbladder, bile is produced but not stored. Modified to low fat diet, then missing gallbladder is not a big deal.

Gallbladder mainly contract and secrets bile in reaction to fatty meals."

[HouseMD]

Hey, I'm not saying stone removal is the worst operation in the world. Most doctors just won't do it because the complication rate is tenfold higher than removing the gallbladder, and, at least in first world countries, doctors really just hate being in court. Over the life of a surgeon, that's a few more trips to the 'ol lawyer nobody wants. Myself, knowing the risks? I'd probably try dissolving the stones or breaking them up, then just go for having the thing out. But hey, that's just me.

Those are some pretty big stones- to give you an idea, the bile duct is about 0.1 cm in diameter, so those stones were never moving. Keep your weight down, lay off the alcohol, drink lots of water, exercise regularly, and eat right and hopefully you'll never have stones again.

I'm a slim guy who doesn't drink except an occasional wine or social drink and I exercise fairly regularly. I have not idea how I developed such big stones over decades.

Could it be that being focused specialists on something so narrow enables them to reduce the normal complication rate to an acceptable level? I've seen this same dynamic play out with certain pioneers in past. For example, hair transplants used to have high resection rates until a handful of doctors figured out how preserve most transplanted hairs, even with dense packing, and many other doctors over time were trained in same technique. Also, consider fat grafting which used to be temporary (most transplanted fat would die within months due to lack of blood supply) until one or more pioneering doctors figured out how to harvest and transplant in a way that a large percentage of the fat would become virtually permanent. Perhaps this hospital in China and maybe a few others there are doing pioneering gallbladder work so that with their techniques, complication rate can be reduced to very low (acceptable level). I've found that in different countries, there are dramatically different techniques and skill levels for given procedures. It seems that some doctors and clinics trial and error their way to expertise over 100s to 1,000s of cases over years and decades. That means earlier patients are like guinea pigs and some may suffer. But once the correct techniques are figured out, future patients benefit. I think Thomas Edison tried out hundreds of substances before he figured out what worked for the lightbulb filament.

They likely have lower complication rates than the usual, but the very nature of stone extraction makes it a higher risk and complication procedure. I mean, theoretically there probably could be better ways to do it- was it laparoscopic or open? And did you have a drain? I'm actually kind of curious lol. Many of the complications in the past have been due to fistulas from the drain or leaking bile, so I'm wondering how they went about it. Also really curious how they closed it- Graham patching might minimize leakage and encourage healing and I don't think it's a technique anyone has ever tried on the gallbladder, but they probably did a purse closure, doubled over, can't remember what the damn thing is called off the top of my head but you use it for small bowel serosal repairs.

Maybe I'll ask about your hospital down the line, sounds like a good study in the making.