What the studies measure after the operation: the surgery itself, how bile changes, symptoms and bowel habit over time, and what is known about the years that follow.
Life after gallbladder removal: the numbers from studies
The human research on what happens after a cholecystectomy, set out number by number, with the study, the people and the time point behind each figure.
About 935,000 gallbladder removals were done in US hospitals in 2019, about 95% of them by keyhole surgery and about two in three without an overnight stay. About 68% were in women.[1]
In planned keyhole surgery, about 1 in 20 people has a complication within 30 days and about 1 in 60 a severe one.[2] Bile duct injury is reported in about 0.1–0.5% of operations, depending on how and when it is counted.[3,4,5]
Biliary colic, the attacks of gallstone pain, stops in about 92–95% of people, compared with symptoms before surgery. Other abdominal symptoms are more mixed: in the long-term studies, about 6 in 10 people are free of abdominal pain by a strict measure, and about 9 in 10 rate their symptoms as better than before.[6,7,8,9]
Bowel habit changes most in the first weeks. One study found loose stools in 2% of people before surgery, 47% at 1 month and 33% at 3 months. Across 21 studies, new diarrhea was reported in 13.3%, with single studies ranging from 2% to 57%.[10,11]
Years later, in a Norwegian population study, 13.0% of women who had had surgery reported much diarrhea in the past year, against 4.7% of women who had not.[12] Among people with lasting watery diarrhea after gallbladder removal who are tested, about 7 in 10 have bile acid diarrhea.[13]
A blood marker of bile acid production roughly doubled within 3 months in one study. Studies that measured production directly found it unchanged or lower, and the total amount of bile acid in the body changed little in the one long-term study; older studies found it smaller.[11,14,15,16]
Large record studies link gallbladder removal with fatty liver, reflux, metabolic syndrome, type 2 diabetes and right-sided colon cancer. These are associations: people who need the operation differ from people who do not, and in several studies the link weakens once that is taken into account. For deaths, the two largest analyses point in opposite directions.[17,18,19,20,21,22,23,24]
Evidence at a glance
What 59 studies report after gallbladder removal
935koperations in US hospitals in 2019
95%done by keyhole surgery
94.8%of people with biliary colic no longer had it at 6 months
13.3%report new diarrhea, across 21 studies
What the studies found, and how much research stands behind it
The research grade measures how much evidence there is and how firm it is. A low grade means a finding is not yet confirmed.
Biliary colic after surgeryFound: Stops in about 92–95% of peopleLarge prospective cohorts and a pooled review, compared with symptoms before surgeryResearchModerate
Abdominal pain months to years laterFound: About 6 in 10 free of pain by strict measures; about 9 in 10 rate symptoms better than beforeFive-year follow-up of a randomized trial and several prospective cohorts, mostly DutchResearchModerate
Diarrhea in the first monthsFound: Reported by 13.3% across 21 studies, with wide differences; higher in the first weeks in the studies that measured earlyMany cohorts with different definitions; two studies with other-surgery controls found little changeResearchEarly
Diarrhea years laterFound: Reported more often than by people who did not have surgeryOne population cohort followed for about six years, and one cross-sectional international surveyResearchEarly
Bile acid diarrheaFound: Found in about 7 in 10 people tested for lasting diarrhea after surgery, and in 4 of 36 people followed after surgery in one studyPeople referred for testing; one study that followed everyone after surgery and scanned those with diarrheaResearchEarly
How bile changesFound: A marker of bile acid production roughly doubled in one study; direct measures and the total pool changed littlePhysiology studies of 9 to 51 peopleResearchEarly
Fat and vitamin absorptionFound: More fat in stool in one study; vitamin D results differA few studies of up to about 100 people; none of vitamins A or EResearchEarly
Body weightFound: No consistent change foundStudies without a comparison group, and one large matched cohortResearchEarly
Bile duct stones laterFound: Found in 1.3–2.3% in single-center seriesSingle-center series and US insurance claimsResearchEarly
Long-term conditionsFound: Associated with several; some links weaken after adjustmentLarge observational studies whose results depend on adjustment and comparison group; no randomized trialResearchEarly
Strong
Moderate
Early
Preliminary
Not yet studied
Research grades are ours, made on the scale described in “How we did this review”. Sources: [1,6,7,10]
The operation in numbers
Gallbladder removal, or cholecystectomy, is one of the most common operations in the United States.[25] The most complete national count is for 2019, from national samples of hospital records, analyzed by a researcher at the National Institutes of Health and a colleague.[1]
The operation
About 935,000 gallbladder removals in US hospitals in 2019
Operations by type and setting
Keyhole, same day605,379
Keyhole, hospital stay279,550
Open, hospital stay48,925
Open, same day1,456
Who had them
Women68%
Under 4541%
45 to 6434%
65 and over25%
Unalp-Arida and Ruhl, from the national hospital surgery and inpatient samples, 2019. The total, the shares by sex and age, and the rounding are our arithmetic from the published counts. Freestanding surgery centers are not counted.[1]
Keyhole surgery is the usual approach. About 95% of the 2019 operations were laparoscopic.[1] In randomized trials against open surgery, keyhole surgery shortened the hospital stay by 3 days and recovery by 22.5 days, with a similar rate of deaths.[26]
Most people go home the same day. About two in three operations in 2019, and 60.8% of cholecystectomies and bile duct explorations in 2014, were done without an inpatient stay.[1,27] After a same-day keyhole operation, 2.8% were readmitted within 30 days, most often for pain, and 90% of those went home after one day.[28]
Who has the operation. About 68% were women, and about 41% were under 45 (including children and teenagers), 34% were 45 to 64, and 25% were 65 or older (our arithmetic from the 2019 counts).[1]
Recovery. Patient guidance from US hospitals gives about one to two weeks before most people return to work after keyhole surgery, and four to eight weeks for full recovery after open surgery.[29,30] The American College of Surgeons advises lifting nothing over 10 pounds for at least 4 to 6 weeks.[31]
Within 30 days
Planned keyhole surgery: complications in 48,564 operations
Swedish national registry, 2015–2023
Any complication5.1%
Readmitted3.2%
Severe complication1.7%
Switched to open surgery1.3%
Reoperation0.7%
Bile leak0.6%
Death<0.1%
Kihlstedt Pasquier 2026: planned laparoscopic operations for benign conditions at 81 Swedish hospitals, excluding people with known duct stones or previous major upper abdominal surgery; 69% women, median age 50. Readmission is from the 39,633 operations after September 2016. Bars run to 6%.[2]
Complication rates depend on who is counted. Planned operations in younger, healthier people have the lowest rates. In Medicare patients, with an average age of 75 and 90% admitted unplanned, complications were recorded in 16.5% in 2021, serious ones in 7.0%, and bile duct injury in 0.12%, down from 0.19% in 2011.[3] Across 151 studies of half a million patients, bile duct injury fell from 0.69% in 1994–99 to 0.22% in 2010–15 in unadjusted figures, and deaths were 0.08–0.14%.[5]
What changes in bile
The liver makes bile all the time. The gallbladder stores and concentrates it between meals and empties it when food arrives. After removal, bile flows from the liver through the bile ducts directly into the duodenum, the first part of the small intestine.[25] Studies that measured bile after surgery, some of them also before it, report these changes:
A marker of bile acid production rises. C4, a blood marker of how much bile acid the liver makes, rose from 25.4 to 46.5 ng/mL one month after surgery and 52.5 ng/mL at three months, in 51 people. The rise was unrelated to changes in bowel habit.[11] Isotope studies that measured production directly found it unchanged or lower.[14,15]
The total bile acid pool changes little. In 12 women followed for 5 to 8 years, the pool was 6% smaller, not a statistically significant change, and the mix of bile acids was much the same.[15] Older studies differ on this, and the pool was smaller in some of them.[16,32]
More bile acid reaches the gut between meals. In 9 women, fasting bile carried more bile acid after surgery, and more cholic acid was turned into deoxycholic acid by gut bacteria (66% against 46%).[14] After a fat-rich meal, bile acid levels in the duodenum were lower than in people with a gallbladder.[33]
Stool carries more bile acid. People who had had surgery had 5.33 mg of bile acid per gram of stool against 3.69 mg in people who had not, with a higher share of deoxycholic acid (53.9% against 41.4%).[34]
The common bile duct widens slightly. In 234 people the average width went from 5.9 to 6.1 mm,[35] and in a US study it widened more in people who had surgery between two scans (3.6 to 4.9 mm) than in people who did not (3.5 to 3.9 mm).[36]
Gut bacteria. A German population study of 580 people found lower bacterial diversity after cholecystectomy.[37] In a study that sampled the same 39 people before and three months after surgery, no significant change was found; the people with gallstones already differed from healthy controls before the operation.[38]
Symptoms after surgery
Most studies ask people about their symptoms before the operation and again afterward. They measure three different things: whether biliary colic stops, whether any abdominal pain remains, and whether new symptoms appear.
After surgery
Pain, and how people rate the change
Free of abdominal pain, by each study's strict measure
12 weeks · Lamberts 201560.5%
6 months · de Jong 202256.8%
5 years · SECURE63.6%
10 years · Lamberts 201460.3%
Rated symptoms better than before surgery
12 weeks · Lamberts 201591.5%
10 years · Lamberts 201489.7%
Biliary colic resolved, among those who had it
6 months · Thunnissen 202394.8%
Each figure from the study named, among people who had surgery for gallstone symptoms. SECURE: the larger of the two trial arms; the other was 63.0%. Bars run to 100%.[6,8,9,39,40]
Editorial note
The “pain-free” figures above come from strict definitions. In the SECURE trial, for example, it means a score of 10 or less on the Izbicki pain score together with 4 or less out of 10 on a pain scale. By the pain scale alone, about 8 in 10 of those who had surgery were pain-free at five years.[8] The same studies that find about 6 in 10 people pain-free also find about 9 in 10 rating their symptoms as better than before surgery.[9,39] The two figures measure different things.
Biliary colic resolved in 94.8% of 345 people who had it before surgery,[6] and pooled studies give 92%.[7]
Other abdominal pain. At six months, 36.5% of 820 people reported some abdominal pain.[6] Upper abdominal pain was relieved in 72% after planned surgery and 86% after emergency surgery.[7]
New symptoms at six months: more frequent bowel movements in 9.6%, urgency in 8.5% and diarrhea in 8.4%.[6] In a German study, 37.1% of people who had no gas before surgery reported it afterward.[41]
Against people who did not have surgery. In a Korean study with matched healthy controls, new functional diarrhea at one year was reported in 6.6% against 0.2%, and new chronic abdominal pain in 11.9% against 4.4%.[42] In a global survey of 54,127 adults, 56.2% of those with a past cholecystectomy had a functional gut disorder, against 42.3% of those without.[43]
Symptoms present before surgery. About two in three people seeking care for gallstones have dyspepsia before the operation.[44] People who had functional dyspepsia or irritable bowel syndrome beforehand were pain-free by the study's measure in 40.7% of cases at six months, against 64.4% of those who did not.[40]
Overall. In 2,481 people having planned surgery at several hospitals, the average number of abdominal symptoms fell from 3.1 before surgery to 1.1 at six months.[45] In a Norwegian follow-up at a median of four years, 94% were satisfied or very satisfied and 1% regretted the operation.[46]
Thunnissen 2023
Symptoms and pain · appraisal
People
820 people with uncomplicated gallstone symptoms who had keyhole surgery (Netherlands); 75% women, mean age 49
Design
Analysis of two prospective studies
Compared with
The same people before surgery
Follow-up
6 months
Measured
Biliary colic, abdominal pain, new symptoms
Result
Biliary colic resolved in 94.8% (327 of 345). Some abdominal pain at 6 months in 36.5%. New since surgery: more frequent bowel movements 9.6%, urgency 8.5%, diarrhea 8.4%.
Limits
No comparison group; analyzed after the fact.
Source: [6] Thunnissen FM, Baars C, Arts R, et al. Persistent and new-onset symptoms after cholecystectomy in patients with uncomplicated symptomatic cholecystolithiasis: A post hoc analysis of 2 prospective clinical trials. Surgery. 2023;174(4):781-786.
Post-cholecystectomy syndrome is the name for symptoms that continue or appear after the operation. It is usually a temporary diagnosis, replaced once tests find a specific cause.[30] Estimates depend on the definition: a pooled analysis of 9 studies gives 3.21%,[47] and a review that counts any continuing symptom gives 5% to 47%, from older studies with differing definitions.[48] Causes found on testing include stones left in or forming in the bile ducts, and conditions such as reflux or irritable bowel syndrome.[30,49]
Bowel habit over time
Studies of bowel habit differ in how they ask and when. An interview question about loose stools gives higher figures than a stool diary, and early time points give higher figures than later ones. The chart sets out each study's own figure at its own time point; the studies are of different people and are not one curve.
Bowel habit
Diarrhea and loose stools, study by study
Sauter 2002 · loose stools, by interview
Before surgery2%
1 month47%
3 months33%
Yueh 2014 · diarrhea, rounded figures
1 week25%
3 months6%
Thunnissen 2023 · new diarrhea
6 months8.4%
Fisher 2008 · troublesome new diarrhea
6–12 months17%
Chang 2023 · new functional diarrhea
1 year, surgery6.6%
Matched controls0.2%
Talseth 2017 · “much diarrhea”, women
About 6 years, surgery13.0%
No surgery4.7%
Each study's own measure at its own time point; the studies are of different people and use different definitions, so the figures are not one curve. Grey: before surgery or a comparison group. Yueh: the summary's percentages do not match its patient count. Bars run to 50%.[6,11,12,42,50,51]
The first weeks. About a quarter of 125 people reported diarrhea at one week and about 6% at three months.[50] Patient guidance from the National Library of Medicine says loose stools after eating may last 4 to 8 weeks, sometimes longer.[52]
Against other surgery. A UK study that kept stool records found no consistent change, and one clearly new case of diarrhea, which was mild.[53] A US study comparing cholecystectomy with hernia repair found the same small fall in diarrhea scores in both groups at 4 to 12 weeks.[54]
Who reports it more. In 98 people, new diarrhea at 6 to 12 months was linked to age under 50, higher body weight and food intolerance after surgery.[51]
Years later. In the Norwegian HUNT study, “much diarrhea” in the past year was reported by 13.0% of women and 5.2% of men a median of about six years after surgery, against 4.7% and 3.1% of people who had not had surgery. Before surgery, 3.4% of these women reported much diarrhea, against 1.9% of women who did not later have surgery.[12]
Talseth 2017
Bowel habit · appraisal
People
931 people who had a cholecystectomy within a Norwegian population health study (HUNT)
Design
Population cohort with surveys before and after
Compared with
People who did not have surgery
Follow-up
Median 6.6 years (women) and 5.4 (men)
Measured
“Much diarrhea” in the past year
Result
After surgery 13.0% of women and 5.2% of men, against 4.7% and 3.1% of people not operated on. Adjusted odds ratio after surgery for biliary colic: women 2.61, men 4.39 (women 2.95 after surgery for cholecystitis or pancreatitis). Before surgery, 3.4% of women who later had it reported much diarrhea, against 1.9% of women who did not.
Limits
One survey question, not a clinical definition.
Source: [12] Talseth A, Edna TH, Hveem K, Lydersen S, Ness-Jensen E. Quality of life and psychological and gastrointestinal symptoms after cholecystectomy: a population-based cohort study. BMJ Open Gastroenterol. 2017;4(1):e000128.
Bile acid diarrhea happens when more bile acid than usual reaches the colon, where it causes the colon to secrete fluid and speeds transit.[55,56] In people with chronic watery diarrhea after cholecystectomy who were tested with a SeHCAT scan, it was found in 70%.[13] In a UK study that followed 36 people for three months after surgery and offered a SeHCAT scan to anyone who developed lasting diarrhea, 4 (11.1%) were diagnosed with bile acid diarrhea.[57] Other tests are a 48-hour stool bile acid test and a fasting blood C4 test.[56] Bile acid binders, prescription medicines, improved stool consistency and frequency in a pooled analysis of placebo-controlled trials (six trials, 182 people with bile acid diarrhea of any cause),[58] and 79% of people with it after cholecystectomy responded in uncontrolled studies.[13]
Fat, vitamins and weight
Fat absorption. In men after cholecystectomy, daily fat in stool was significantly higher than in men of the same age, on similar diets; the published summary gives no figures.[59]
Vitamin D. Results differ by study. In 78 people tested before and after surgery, median vitamin D was 19.76 and 19.13 ng/mL, with no significant change.[60] In 103 postmenopausal women, vitamin D fell slightly but significantly over three months.[61] Clotting tests, a marker of vitamin K, did not change in 101 people tested at least a week after surgery.[60] We found no before-and-after studies of vitamins A or E.
Bones. Across four cohort studies of more than 1.5 million people, fractures were slightly more common after cholecystectomy (hazard ratio 1.07), mainly under age 50.[62]
Weight. In a UK study without a comparison group, 75 of 103 people gained weight in the six months after surgery; many had been advised to avoid fat before it.[63] In a Korean study with matched controls, the change in body mass index did not differ.[64] In a US respiratory-chamber study, people who had had surgery burned about 78 kcal a day more while asleep.[65]
Bile duct stones after surgery
Stones can be found in the bile duct after the gallbladder is gone, either left behind at surgery or formed later. Cleveland Clinic puts this at up to 5% of patients.[66] Single-center series report 1.3%, 1.5% and 2.3%.[67,68,69] In a series of 40 people from Iceland's national university hospital, 77.5% of these stones were found within two years of surgery.[70] In US commercial insurance claims, first ERCP procedures more than a year after cholecystectomy rose from 0.5 to 4.2 per 1,000 person-years between 2005 and 2021. Of these, 44% removed a stone, and the procedures were most closely linked with gut-brain disorders and other conditions that can resemble duct stones.[71]
A stone that blocks the duct can cause pain in the upper right abdomen lasting 30 minutes or more, fever, yellowing of the skin and clay-colored stools.[72] MedlinePlus advises contacting a provider for these symptoms, including after gallbladder removal.[72]
Long-term health: what the large studies report
Several conditions have been studied in large record-based cohorts that compare people who had a cholecystectomy with people who did not. The figures below are the pooled or largest estimates for each.
Reflux disease · Huang 2024 · 95% CI 1.09–1.72RR 1.37
Metabolic syndrome · Huh 2023 · 95% CI 1.17–1.23OR 1.20
Right-sided colon cancer · 9 cohorts (Mu 2023) · 95% CI 1.04–1.38RR 1.20
Colorectal cancer · gallstone disease (Polychronidis 2023) · 95% CI 1.02–1.19RR 1.10
Fractures · Sun 2025 · 95% CI 1.05–1.10HR 1.07
Heart disease · Song 2024 · 95% CI 0.77–1.37RR 1.03
Deaths · Song 2024 · 95% CI 1.03–1.34RR 1.17
Deaths · Emilsson 2026 · 95% CI 0.90–0.92HR 0.91
0.511.523ratio
The line marks 1: no difference between the groups
Each bar spans the 95% confidence interval; the figure on the right is the estimate. OR odds ratio, RR risk ratio, HR hazard ratio, each against people without a cholecystectomy (Polychronidis: without gallstone disease). Log scale. Associations, not effects of surgery.[17,18,19,20,21,22,62,73]
Reading these figures
These figures come from observational studies and show associations; they cannot show what the operation itself causes. People who need a cholecystectomy differ from people who do not: gallstones share risk factors with several of these conditions, including obesity and diabetes.[74] In the Rotterdam Study, the links with metabolic syndrome and fatty liver disappeared after adjustment for metabolic factors.[24] Results also depend on the comparison group: against healthy people heart disease was more common after surgery, and against people with gallstones it was less common.[21]
Liver. Fatty liver disease odds ratio 1.54, pooled from 7 studies in a review of 20.[17]
Metabolism. Metabolic syndrome odds ratio 1.20 and type 2 diabetes about 20% more common in Korean cohorts matched by age and sex, against people who had not had the operation.[19,23]
Reflux. Reflux disease (GERD) risk ratio 1.37, with no increase in esophageal cancer.[18] In a US study with hernia-repair controls, reflux symptoms did not rise in the 4 to 12 weeks after surgery.[54]
Colorectal cancer. One meta-analysis found no association overall and a risk ratio of 1.20 for right-sided colon cancer;[20] another, of gallstone disease as a whole, found 1.10 in population-based and cohort studies (1.15 including hospital-based studies) and 1.16 for the proximal colon.[73]
Deaths. A meta-analysis of six studies found all-cause deaths 17% more common.[21] A Swedish national cohort of 159,946 people operated on between 1969 and 2016, followed for a median of 12 years, found them 9% less common, except at ages 20 to 39.[22]
What we still don't know
How many cholecystectomies are done in freestanding US surgery centers, which national counts leave out.[1]
How bowel habit changes week by week after surgery. The earliest time point in the studies we found is one week.
How bowel habit changes over many years in the same people, measured against people who did not have surgery, in the US.
How often bile acid diarrhea develops in everyone who has the operation, rather than in people referred for testing.
Whether vitamins A and E change after surgery; we found no before-and-after studies. Vitamin K has been studied only indirectly, through clotting tests.
Whether the long-term associations reflect the operation, the gallstone disease that led to it, or the health of the people who have it. No randomized trial has followed people long enough to tell.
All 59 studies
Every study in this review, set out on the same fields. “Not stated” means the source we could read is silent on it. On a phone, scroll the table sideways.
Complications 1.6–5.3%; deaths 0.08–0.14%; any bile duct injury 0.32–0.52% (major injury 0.28% in the 65 studies that separated it), falling from 0.69% (1994–99) to 0.22% (2010–15) in unadjusted pooled figures.
All US cholecystectomies in hospital settings, 2019 (national samples of hospital records)
Analysis of national databases
None
Not applicable
Number of operations by setting, sex and age
605,379 laparoscopic and 1,456 open operations without a hospital stay; 279,550 laparoscopic and 48,925 open with one. About 935,000 in all, 68% in women (our sum).
Hospital-owned facilities only; freestanding surgery centers and federal facilities are not counted; includes children.
48,564 planned laparoscopic operations at 81 Swedish hospitals, 2015–2023; 69% women, median age 50
National registry study
None
30 days
Complications, readmission, deaths
Any complication 5.1%; severe 1.7%; bile leak 0.6%; reoperation 0.7%; readmission 3.2%; switched to open surgery 1.3%; 7 deaths (under 0.1%). Median hospital stay 0 days.
Bile acids in fasting bile rose relative to bilirubin; the share of cholic acid turned into deoxycholic acid rose from 46% to 66%; cholesterol saturation fell 27%.
C4 (a blood marker of bile acid production), bowel habit
C4 rose from 25.4 to 46.5 ng/mL at 1 month and 52.5 at 3 months. Loose stools: 2% before, 47% at 1 month, 33% at 3 months; intermittent diarrhea 6% at 3 months. The C4 rise was unrelated to the change in bowel habit.
Single center; bowel habit by interview; no comparison group.
580 people after cholecystectomy, 404 with gallstones, 984 controls (Germany)
Population-based cross-sectional study
Controls and people with gallstones
Not applicable
Gut bacteria in stool
After cholecystectomy: lower bacterial diversity, less Faecalibacterium, more Escherichia/Shigella. People with gallstones did not differ from controls.
Measured once, so it cannot show whether the changes followed surgery.
468 of 508 people after keyhole surgery, 1989–1991 (Germany)
Prospective audit
The same people before surgery
Mean 19 months
Eight abdominal symptoms, overall result
Improved 96.8%; some abdominal symptoms 55.6%. Colic 82.9% before, 6.4% after. Gas 62.6% before, 45.3% after; new gas in 37.1% of those without it before.
Early keyhole era; single center; diarrhea not asked about.
Studies of adults followed at least 1 month after cholecystectomy
Systematic review with pooled figures
Before surgery
At least 1 month
Relief of each symptom
Biliary pain relieved in 92%; upper abdominal pain in 72% after planned and 86% after emergency surgery; food intolerance in 88% with follow-up up to a year and 65% beyond it.
One database searched; the authors say the studies cannot show the relief was due to surgery.
820 people with uncomplicated gallstone symptoms who had keyhole surgery (Netherlands); 75% women, mean age 49
Analysis of two prospective studies
The same people before surgery
6 months
Biliary colic, abdominal pain, new symptoms
Biliary colic resolved in 94.8% (327 of 345). Some abdominal pain at 6 months in 36.5%. New since surgery: more frequent bowel movements 9.6%, urgency 8.5%, diarrhea 8.4%.
1,067 people with abdominal pain and gallstones in a randomized trial (Netherlands); median age 49, 74% women
5-year follow-up of a randomized trial
Two ways of choosing who has surgery
5 years
Pain-free by the trial's measure, satisfaction
Among those who had surgery, 63.6% and 63.0% were pain-free by the trial's measure, and about 8 in 10 by the pain scale alone. Median satisfaction in each trial arm as a whole: 9.0 and 8.9 out of 10.
About a third of the 5-year data are missing; “pain-free” is a score threshold, not complete freedom from pain.
931 people who had a cholecystectomy within a Norwegian population health study (HUNT)
Population cohort with surveys before and after
People who did not have surgery
Median 6.6 years (women) and 5.4 (men)
“Much diarrhea” in the past year
After surgery 13.0% of women and 5.2% of men, against 4.7% and 3.1% of people not operated on. Adjusted odds ratio after surgery for biliary colic: women 2.61, men 4.39 (women 2.95 after surgery for cholecystitis or pancreatitis). Before surgery, 3.4% of women who later had it reported much diarrhea, against 1.9% of women who did not.
5,210 people after cholecystectomy and 49,457 matched controls (South Korea)
Matched cohort from national health records
Matched people without surgery
Not stated
Weight change, heart disease
No difference in change in body mass index (−0.13). Cardiovascular disease more common in the first 2 years (adjusted hazard ratio 1.35), less so after.
55,166 people after cholecystectomy and 110,332 matched controls (South Korea)
Matched cohort from national health records
Matched people without surgery
About 4.7 years
Type 2 diabetes
About 20% higher risk after adjustment. Against people with neither, hazard ratio 1.29 for cholecystectomy without obesity, 1.41 with obesity, and 1.24 for obesity alone.
Observational; controls matched only by age and sex; gallstone status of controls not stated.
65 observational studies of gallstone disease and colorectal cancer
Meta-analysis
People without gallstone disease
Varied
Colorectal cancer
Risk ratio 1.10 (95% CI 1.02–1.19) in population-based and cohort studies; 1.15 overall, a figure driven by hospital-based case-control studies; 1.16 for the proximal colon; none for the distal colon or rectum.
Combines gallstones and cholecystectomy; includes case-control studies.
Taken from each study's published summary, or its full text where marked. Searched October 18, 2026.
How we did this review
Search. On October 18, 2026 we searched PubMed and Europe PMC for cholecystectomy combined with terms for surgical outcomes, complications, bile duct injury, readmission, recovery, symptoms, pain, satisfaction, diarrhea, bile acid diarrhea, bowel habit, bile acid metabolism, bile duct width, gut bacteria, fat and vitamin absorption, weight, bile duct stones, fatty liver, metabolic syndrome, diabetes, reflux, colorectal cancer and mortality, logging 74 searches in all. We searched ClinicalTrials.gov for registered studies with posted results, read the national surgery counts from the Agency for Healthcare Research and Quality, and reused sources already checked for our Journal.
What we included. Studies in adults who had their gallbladder removed, reporting a number for an outcome after surgery: national counts and registries, randomized trials, cohorts with or without a comparison group, physiology studies and meta-analyses. Where several studies measured the same thing, we included the largest, the most recent and those with a comparison group. We excluded studies in children, studies only of the choice whether to operate, and studies of supplements or diets. TUDCA is covered in our separate reviews of its human evidence and its safety.
How we appraised them. For every study we recorded the same fields: who took part, the design, the comparison, the follow-up, what was measured, the result and its limits. We took them from the study itself and wrote “not stated” where it does not say. Where a figure is our own arithmetic from a study's numbers, we say so.
How we graded the evidence. Each question gets two things: what the studies found, and a grade for how much research stands behind that finding. The grade describes the research, not the operation. A low grade means a finding has not yet been confirmed, not that it has been disproved.
Strong: consistent results from several large studies with a comparison group, or randomized trials, measuring outcomes that matter to patients.
Moderate: consistent results from several large prospective studies, or one randomized trial.
Early: a few studies with a comparison group, several smaller studies whose results differ, or large observational studies whose results depend on adjustment or the comparison group.
Preliminary: one or two studies that were small, uncontrolled or measured once.
Not yet studied: no published study in people.
Limits of this review. For most studies we could read only the published summary. Many studies come from a small number of countries, several from overlapping Dutch patient groups, and few from the US. We could not search Embase or databases in Chinese or other languages.
Conflict of interest. Dr.Primal sells a TUDCA supplement and markets it to people who have had their gallbladder removed. That is why we have kept this page free of product links and offers, and set out every study in the same way.
Medical review. This review has not been checked by a physician. The Dr.Primal editorial team wrote it and fact-checked every figure against its primary source. If a credentialed reviewer checks it later, we will name them here and record it in the version history.
Versions. Version 1.0, October 18, 2026: first publication. We will update this page when new studies are published, and record every change here.
Corrections. If you find an error or a study we missed, please tell us.
Cite this pageDr.Primal Editorial. Life after gallbladder removal: the numbers from studies. Version 1.0. Dr.Primal; October 18, 2026. https://drprimal.com/pages/life-after-gallbladder-removal
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This review describes published research. It is not medical advice and does not replace advice from your doctor. If you have severe or worsening abdominal pain, fever, yellowing of the skin or eyes, dark urine or pale stools, contact a doctor.
