Bile Acid Pools, Kinetics and Biliary Lipid Composition before and after Cholecystectomy

Bile acid pools, kinetics and biliary lipid composition were determined in 10 patients with cholesterol gallstones before and after cholecystectomy. The determinations of post-cholecystectomy bile acid pools were carried out three to 41 months after surgery. Cholecystectomy had no significant effect on biliary lipid composition, and the bile remained lithogenic after removal of the gallbladder. The total bile acid pool in the patients was small before cholecystectomy (about 1.0 g), and there was no significant change in bile acid pool size after removal of the gallbladder. Cholic and chenodeoxycholic acid synthesis did not change after cholecystectomy. The fractional daily turnover rate of cholic and chenodeoxycholic acid was significantly greater after cholecystectomy. These findings support the view that the gallbladder does not have an important role either in the formation of lithogenic bile or in the reduction of bile acid pool size observed in patients with cholesterol gallstones. (N Engl J Med 289:1213–1216, 1973)