Gallbladder removal didn’t stop gallstones

DEAR DR. ROACH: My husband had his gallbladder removed many years ago. In the past few years, he has had six ERCPs to remove gallstones from his bile duct, as he is still making them. He has been told to drink lots of water but that there is no preventive remedy. Do you have any suggestions? — B.A.P.

ANSWER: Ordinarily, removing the gallbladder stops new gallstones from forming. Having a gallstone left after surgery is not uncommon, but it is very uncommon for people to make multiple new stones years after surgery.

One possibility is a diverticulum of the common bile duct. The common bile duct drains bile from the liver and gallbladder into the small intestine; it drains pancreatic fluid, too. A diverticulum is a blind pouch. It’s possible for a stone to form there, so you should find out if he has one. They should have seen it on one of the ERCPs (a special endoscopy that looks at the bile and pancreatic ducts). If present, a diverticulum can be removed surgically.

I asked my colleague, Dr. Arun Jesudian, for his expertise, and he said he has seen multiple stones in the liver due to parasitic infections, often in Asian patients. That may require surgical treatment. He also discussed doing a sphincterotomy, which is a procedure to open the end of the common bile duct, to let stones pass through easily. Your husband may benefit from expanding it. Finally, there is a medication to reduce gallstones, ursodiol (Actigall), which Jesudian feels had no real downsides and might well help.

(Roach is a columnist for the North American Press Syndicate. Write to him at 628 Virginia Drive, Orlando, FL 32803.)