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

Question

I cant absorb fat because of these issues, I've gained weight and unless I eat about 800-1000 cals a day, It's hard to lose weight and it's so hard to stick to that low of cals. I was wondering if weight loss surgery would help with weight loss or would it make my current issues worse.

Ali Solmaz, MD · Answer

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.

Ariel Ortiz, MD, FACS · Answer

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

Jay Roberts, DO, FACOS, FASMBS · Answer

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.

Pablo Garcia, MD - Account Suspended · Answer

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.

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

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