Do I Need My Gallbladder Removed During Splenectomy?

If you are planning to have a splenectomy (spleen removal) to treat Hereditary Spherocytosis (HS), your surgical team may also recommend removing your gallbladder at the same time—a procedure called a cholecystectomy. Whether you need your gallbladder removed during your splenectomy depends entirely on whether you already have gallstones ^[1]. If an ultrasound shows that you have gallstones or gallbladder “sludge,” most surgeons will recommend removing the gallbladder during the same surgery ^[2]. If your gallbladder is clear and healthy, it is generally left in place.

Why Are Gallstones Common in Hereditary Spherocytosis?

People with HS have fragile red blood cells that break down prematurely, a process called hemolysis ^[3]. When these cells break down, they release a yellow pigment called bilirubin. The liver processes bilirubin and sends it to the gallbladder to be mixed into bile. However, in people with HS, the constant breakdown of red blood cells produces more bilirubin than the gallbladder can process efficiently. Over time, this excess bilirubin crystallizes into what are known as pigment gallstones ^[4].

When Is Concurrent Gallbladder Removal Recommended?

The decision to remove the gallbladder during a splenectomy usually falls into one of three categories:

• If you have gallstones and symptoms: If you experience symptoms like upper right abdominal pain, nausea, or jaundice, removing the gallbladder alongside the spleen is the standard clinical approach ^[2]. This resolves the symptoms and prevents complications like blocked bile ducts ^[4].
• If you have gallstones but no symptoms: Even if your gallstones have never caused you pain, many surgical teams will recommend removing your gallbladder during your splenectomy. Research shows that leaving a gallbladder with stones inside often leads to problems later, with a high chance that you will need a second, separate surgery to remove it down the road ^[1].
• If you do not have gallstones: If a pre-surgery ultrasound shows that your gallbladder is completely clear of stones and sludge, it is generally not removed. Once your spleen is removed, the rate at which your red blood cells break down will decrease significantly, which greatly lowers your risk of forming new gallstones in the future ^[2].

Is It Safe to Have Both Surgeries at Once?

Having a splenectomy and a cholecystectomy at the same time (known as a concurrent or combined procedure) is a common, established practice for people with HS ^[2]. These procedures are often performed laparoscopically (minimally invasive) to reduce recovery time. Clinical data shows that combining these surgeries is safe and feasible ^[5]. Having both organs removed at the same time does not typically result in longer hospital stays, higher readmission rates, or an increase in surgical complications compared to having just the spleen removed ^[6].

By addressing both the spleen and the gallstones in a single operation, you avoid the physical toll, recovery time, and risks associated with undergoing a second general anesthesia and abdominal surgery in the future ^[1].

What is Life Like Without a Gallbladder?

While having both organs removed is clinically safe, it is important to understand how your digestion might change after your gallbladder is gone. The gallbladder acts as a storage tank for bile. Without it, your liver will continue to produce bile, but it will flow continuously into your intestines rather than being released in large bursts when you eat.

As your body adjusts, you may experience mild digestive changes:

• Difficulty with high-fat foods: Because you no longer have a concentrated “boost” of bile to help digest heavy or greasy meals, eating high-fat foods can lead to bloating or flatulence ^[7].
• Digestive changes: In the early recovery phase, the continuous flow of bile can act as a laxative, causing watery bowel movements or diarrhea ^[8].

For most people, these changes are mild and temporary. Your surgical team will likely recommend eating a low-fat diet immediately after surgery and gradually reintroducing other foods as your body adapts.