Alterations in Hepatic Bile Composition After Cholecystectomy

Abstract

Hepatic bile biochemistry has been studied by aspiration of the common bile duct at the time of cholecystectomy in 23 patients with cholesterol gallstones and by duodenal aspiration in 17 patients 3 or more months after cholecystectomy, and in 10 control subjects without gallbladder disease. In 10 of the cholesterol gallstone patients, bile was studied both at the time of cholecystectomy and again 3 to 6 months after surgery. The results confirmed previously reported findings that hepatic bile from patients with cholesterol gallstones at surgery contains an excess of cholesterol relative to bile salts and phospholipids. Calculation of the bile salts + phospholipid-cholesterol and phospholipid-cholesterol ratios, and plotting the data on triangular coordinates indicated that, after the removal of the gallbladder, the hepatic bile was better able to maintain cholesterol in solution. It is suggested that the biochemical abnormality reported in hepatic bile of patients with cholesterol gallstones is not necessarily continuous and that in some patients the lipid composition of the bile reverts to a more normal pattern following cholecystectomy.