I have post-cholectomy syndrome, bile salt malabsorption. Would gastric sleeve or RNY potentially help?

Since you have post-cholecystectomy syndrome and bile salt malabsorption, weight loss surgery could be helpful, but it also comes with risks.
Without a gallbladder, your bile constantly drips into the intestines instead of being released in controlled amounts, which can lead to diarrhea, bloating, and difficulty absorbing fats. Bile salt malabsorption makes this worse by preventing proper reabsorption of bile, leading to chronic diarrhea and potential deficiencies in fat-soluble vitamins like A, D, E, and K.
If you choose the gastric sleeve (VSG), it could make bile reflux worse. Since VSG does not reroute the intestines, bile can more easily flow back into the stomach and esophagus, which may lead to nausea, burning, and discomfort. However, VSG does allow for more normal digestion and absorption of nutrients compared to gastric bypass.
Roux-en-Y gastric bypass (RNY) may actually help with bile reflux because it reroutes digestion, preventing bile from entering the stomach. This could reduce symptoms like nausea and burning. However, RNY also reduces the absorption of nutrients, which could worsen your existing difficulty with absorbing fat-soluble vitamins.
If bile reflux is already a problem for you, RNY might be the better choice because it helps prevent it. If you are more concerned about maintaining nutrient absorption, VSG may be safer, but it could increase the risk of bile reflux. Either option would require strict vitamin supplementation and careful dietary management.

Hello, I hope you are well. I am sorry to hear you are struggling with your weight, as well as fat malabsorption. It most definietely sounds like you are not following a healthy eating plan. However, fat malabsorption is associated with weight loss, not weight gain. A gastric sleeve should ot have any negative effects on this issue as it does not iterfere with nutrient absorption, it just diminishes the capacity of your stomach.

Many patients with post-cholecystectomy syndrome will benefit from an endoscopic retrograde cholangiopancreatography (ERCP) procedure either to aid in diagnosis and treatment, with a gastric sleeve a standard ERCP can be performed but not with RYGB surgery. RYGB can also increase malabsorption which would impact negatively a patient that develops lower intestinal symptoms after cholecystectomy such as colic pain or diarrhea after meals. I would suggest sleeve gastrectomy.
AMG

Yes weight loss surgery will help. Your issues with diarrhea may or may not improve. Often after enough time the problems you have will likely resolve. I would choose sleeve or bypass based on your current bmi and medical problems. For bmi less than 45 without diabetes a sleeve is probably fine. If your bmi is greater than 45 or you have DM I’d recommend bypass. If serious reflux issues probably also bypass.