The majority of SOD patients report SOD symptoms appeared after gallbladder surgery (cholecsytectomy). Therefore we chose to include questions about their gallbladders in our annual survey. In addition, we sought to gauge if cholecystectomy was necessary; if it could have been avoided; and when SOD symptoms began--before or after cholecystectomy.
Rather than go into great detail about the gallbladder and cholecystectomy, there is a wealth of information online regarding cholescystectomy and gallbladder health. The University of Maryland provides an excellent over of Gallstones and Gallbladder Disease, including symptoms, risks, diagnosis, and treatment. Unfortunately they and other sites describe the gallbladder as a non-essential organ. This belief does not bode well for the 10-15% experiencing post-cholecystectomy syndrome (Jensen and Giebel). Another good resource is Wikipedia(but as with anything on Wikipedia, ensure citations/references are valid).
Though the American College of Physicians advises a conservative "wait and see" approach to gallbladder diseases, 600,000 are treated with cholecystectomies every year (Goldman, 2011). Cholescystecomy is not without risks. A study following 9,542 cholecystectomy patients over nine years (Duca, et al) found these risks: haemorrhage (224 cases, 2.3%), iatrogenic perforation of the gallbladder (1517 cases, 15.9%) and common bile duct (CBD) injuries (17 cases, 0.1%). Conversion to open operation was necessary in 184 patients (1.9%), usually due to obscure anatomy as a result of acute inflammation. The main postoperative complications were bile leakage (54 cases), haemorrhage (15 cases), sub-hepatic abscess (10 cases) and retained bile duct stones (11 cases). Ten deaths were recorded (0.1%).
Below are our 2014 annual survey outcomes. To view the results of our 2013 annual survey click here.
SOD Patients and the Gallbladder
Other reasons: Biliary dyskinesia (6), Inflammation (2), Overactive, Non contractile, Prerequisite for botox injection (2), Removed at same time as appendix, Enlarged—bursting (1), Gangrenous, Acute pancreatitis, Sluggish, Suspicious cancer growth/polyp (2), To rule out gallbladder dysfunction, Diagnostic Reasons, Sludge (7), Chronic Pain (mostly RUQ) (12), Fever, Low HIDA scan ejection (12).
The decision to perform cholecystectomy on some patients is warranted and will produce positive outcomes. However, for others, the decision to perform cholecystectomy is questionable. In every surgeons' defense, it is difficult to conclude whether cholecystectomy could have been avoided in our survey participants as we did not ask for a thorough medical history from each respondent. If we were to go by survey answers alone, it is obvious some surgeries could be prevented, namely those with normal imaging, HIDA scan and/or bloodwork findings. Gallstones and sludge can be extracted via ERCP and some managed through medication and/or stents. Considering the risks of cholecystectomy and potential for developing post-cholecystectomy syndrome, it is questionable to perform this surgery solely for chronic pain, inflammation, diagnostic reasons, fever (that is not connected to gallbladder dysfunction), and any symptoms that could be caused by SOD, pancreatitis (not caused by a stone blockage), or a biliary disorder. Most disconcerting is the 9.5% (14) survey participants who had no idea why their gallbladder was removed.
Question: When did SOD symptoms begin after gallbladder removal? (includes # of respondents and % (189) respondents): Immediately: 27 (14%), Within first month: 47 (25%), One month-6 months: 24 (13%), 6 months-one year: 22 (12%), One year-5 years: 16 (8%),5+ years: 15 (8%), Before gallbladder was removed: 23 (12%), Unsure or didn’t have gallbladder removed: 15 (8%).
As suspected the majority of SOD sufferers developed SOD symptoms after their gallbladder was removed--most within six months (52%). In those who had SOD symptoms prior to gallbladder removal, it makes us wonder if cholecystectomy was needed, especially if it was performed for diagnostic reasons or chronic pain.
Other SOD symptoms: Ehlers-Danlos: Hypermobility, Polycystic Ovarian Syndrome (PCOS), Pelvic Congestion, Endometriosis, Hashimoto’s, High Blood Pressure, POTS, Dysautonomia, Kidney Stones. Most of these were unique or described specific medications. Some were duplicates fitting into the list questions.
The purpose of this question was to identify trends in symptoms occurring prior to SOD symptom onset. The most common symptoms shared by respondents were: acid reflux, allergies, bowel disorders, headaches, joint pain or inflammation, medication use (most popular were birth control, proton pump inhibitors (PPIs) and antidepressants), and menstrual issues. The high prevalence of women with SOD reporting menstrual, hormonal, or other female issues leads to the theory hormones play a strong role in the development of SOD and need for research thereof. Studying the prior use of medications like PPIs, birth control, and antidepressants by SOD sufferers would be of great interest as well.
References: Jensen, Steen and Geibel, John (2014). Post Cholecsytectomy Syndrome.Medscape. Goldman, Lee (2011). Goldman's Cecil Medicine (24th Ed.). Philadelphia: Elsevier Saunders. p. 855 S Duca, O Bala, N Al-Hajjar, C Iancu, IC Puia, D Munteanu, and F Graur (2003). Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB (Oxford). 5(3): 152–158.