The Gallbladder: The Underappreciated Organ.

The gallbladder is a small, often overlooked organ that nevertheless plays a central role in ensuring smooth digestion. It stores and concentrates the bile produced by the liver and releases it exactly when the body needs it—namely, to aid in the digestion of fats. It is only when symptoms arise that many people realize just how finely tuned this system is and how significantly impaired gallbladder function can affect the entire digestive tract.

The gallbladder performs a far more complex task in the digestive system than its small size would suggest. Its primary function is not merely to store bile, but to concentrate, regulate, and release this fluid at the right moment so that fat digestion can proceed efficiently. 

“The gallbladder is often underestimated because many people believe it can simply be removed without significantly impairing the digestive system. In fact, however, it is dispensable only when it is diseased. As long as it is healthy—and fortunately, this is very often the case—it plays an important role in the digestive process. Anyone who has ever had an intestinal infection knows how sensitive this system is and how even minor disruptions can throw the entire body out of balance. The gallbladder acts as a sort of fine-tuning mechanism in the digestive system. The liver does produce bile continuously—up to one and a half liters a day—which is released into the duodenum. But the idea that removing the gallbladder would have little effect is misleading. In its small reservoir of about one hundred milliliters, the bile is concentrated by removing water. Whenever we eat, the hormone cholecystokinin is released, which stimulates the gallbladder to contract. This causes it to release the concentrated bile, which is essential for fat digestion. “The gallbladder is therefore far more than a simple storage organ. It regulates, concentrates, and releases bile precisely when it is needed. It is precisely this precise control that makes it clear why the organ should not be underestimated,” Prof. Dr. Soysal makes clear at the beginning of our conversation.

Early warning signs of declining gallbladder function are often so nonspecific that they go unrecognized for a long time. 

“When the gallbladder is no longer functioning properly, this often first manifests as very nonspecific symptoms. Many people do not feel any distinct pain, but rather a sensation of pressure in the upper right abdomen, sometimes radiating to the back. An unpleasant feeling of fullness often occurs after eating, accompanied by bloating. This is because bile is responsible for breaking down fats: If not enough concentrated bile is released, fats cannot be properly processed in the intestines. This leads to fermentation processes, which in turn cause increased gas production and a bloated feeling. Over time, the symptoms may worsen. Some people notice fatty stools—the stool floats in water because it contains undigested fats. This is a sign that the gallbladder is not producing enough bile. Recurring digestive problems are also typical indications that the gallbladder is no longer functioning properly. The causes vary. High-fat meals can exacerbate these symptoms because they place greater strain on the gallbladder. Often, however, an underlying organic disorder is to blame, such as gallstones or chronic inflammation, which prevents the gallbladder from emptying completely. Large or small stones, repeated episodes of inflammation, or a chronically irritated gallbladder wall can prevent bile from being properly concentrated and released—and that is precisely when the symptoms described above occur,” explains Prof. Dr. Soysal.

Man with pain_AI-generated

To distinguish between harmless, functional complaints and gallbladder diseases that actually require treatment, a combination of clinical assessment, targeted imaging, and laboratory analysis is needed. 

Regarding diagnosis, Prof. Dr. Soysal explains: “If the gallbladder becomes sluggish or inflammation develops, this can usually be clearly diagnosed. The process always begins with a clinical examination, followed by a blood draw to check inflammation markers and other laboratory parameters. The most important imaging method is ultrasound, as it reveals typical changes such as a thickened gallbladder wall or the presence of gallstones. Combining these findings with elevated inflammatory markers in the blood allows for a good assessment of whether the condition is acute or chronic and whether complications from gallstones are present. It is interesting to note that gallstones alone rarely lead to acute inflammation—about 80% of those affected have no symptoms at all, and less than 2% actually develop acute cholecystitis. Therefore, the detection of stones does not automatically mean that surgery is necessary. The decisive factor is quality of life: recurring pain, colic, or digestive problems are the reasons why removal of the gallbladder is recommended. Very large stones measuring over 2.5 cm are an exception, as they increase the risk of inflammation even in the absence of symptoms. In such cases, surgery is advised because these stones cannot be dissolved with medication and their composition is unknown. Conservative measures are only considered if there is no acute inflammation and the symptoms are mild. These include taking pain relievers as needed and avoiding high-fat foods to relieve pressure on the gallbladder, combined with antibiotic therapy. However, it is not possible to dissolve gallstones with medication—unlike with some kidney stones, there are no effective medications for this purpose. If stones cause symptoms or the gallbladder is pathologically altered, the entire organ is removed. This is a common misconception: You cannot simply remove the stones and leave the gallbladder in place, because the organ itself is usually the source of the problem. The removal is performed using a minimally invasive technique and is considered a minor, low-risk procedure.”

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Gallbladder removal is recommended when the organ causes recurrent biliary pain, nighttime attacks, colic, or inflammatory changes and thus becomes a risk factor. Even “silent” stones may require treatment if they threaten the bile duct or show signs of chronic inflammation on ultrasound. In cases of acute cholecystitis, hydrops, porcelain gallbladder, or stones in the bile duct, there is a clear indication for surgery. The standard procedure is laparoscopic cholecystectomy (gallbladder removal), which is gentle and associated with a quick recovery. Whether this procedure is possible depends on the individual findings: severe inflammation, adhesions, anatomical variations, or an unstable general condition may necessitate an open surgical approach. If stones are present in the bile duct, an ERCP (endoscopic retrograde cholangiopancreatography) may also be required. In specialized centers, the laparoscopic technique is safely performed even in cases with complex findings.

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In the long term, digestion changes less drastically after gallbladder removal than many people fear, but it functions differently than before. Without a gallbladder, bile is no longer stored and concentrated; instead, it flows continuously and in smaller amounts from the liver directly into the duodenum. This means that fat digestion is supported less “in bursts,” and the body must adapt to a new form of regulation. 

“When the gallbladder is diseased and no longer functions properly, digestion changes noticeably because, although the liver continues to produce bile, it can no longer concentrate it or release it in measured doses. Without the gallbladder, bile flows continuously and in smaller amounts directly into the duodenum, rather than in a concentrated surge as before. For patients with an actually diseased gallbladder, this is usually a significant improvement: After surgery, digestion returns to normal, symptoms such as pressure, colic, or bloating disappear, and quality of life improves noticeably. It is important to note, however, that only those whose gallbladder is truly dysfunctional benefit from this procedure. If a healthy or only mildly impaired gallbladder is removed, the symptoms often persist because the cause did not lie in the organ itself. “Some patients develop loose stools or a feeling of fullness after removal—a condition known as postcholecystectomy syndrome—which can occur despite a successful operation,” explains Prof. Dr. Soysal, who also mentions preventive measures for gallbladder health:

“To keep the gallbladder as healthy as possible, it’s worth considering the factors that promote the formation of gallstones. Stones form when the delicate balance of the gallbladder’s components—water, bile acids, phospholipids, and cholesterol—is disrupted. Much like mayonnaise, which curdles when the mixture is off, crystals form that can later turn into stones. Prolonged periods of fasting, very rapid weight loss, extremely low-calorie diets, or certain medications can affect this balance. Hormonal factors also play a role: Women are affected significantly more often, especially during pregnancy, because elevated estrogen and progesterone levels slow the emptying of the gallbladder and alter the metabolism of the bile components.”

Low-fat, easily digestible foods_AI-generated

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In the first few weeks after gallbladder removal, loose stools, bloating, or a feeling of pressure after high-fat meals are normal because the bile is no longer concentrated and available at the right time. However, the body adapts well to this: the liver and intestines adjust their functions so that most people can return to a largely normal diet after a few months. Initially, low-fat, easily digestible foods and several small meals are helpful; later, higher-fat foods can be gradually reintroduced. Dietary fiber supports bowel regularity in the long term, as it binds excess bile acids. Warning signs such as persistent pain, yellowing of the skin, or severe digestive problems should be evaluated by a doctor, as they may indicate rare complications.

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Although gallbladder removal is considered a minor, routine procedure, patients should still ensure they are in the hands of experienced surgeons. 

“Technically, the surgery is generally manageable for well-trained surgeons and is even used in many hospitals as a standard training procedure for resident physicians. Nevertheless, it should not be underestimated, as the anatomy around the gallbladder is variable, the structures are closely spaced, and small mistakes can have major consequences. Anyone who fails to account for anatomical variations in the vessels and bile ducts or operates too aggressively can turn a simple procedure into a complicated situation. Experienced surgeons know that the overall risk is very low—statistically well below 0.5 percent. For the individual patient, however, this means either no problem at all or a serious complication. That is why care is crucial: critical points must be taken into account, the anatomy must be precisely identified, and every step must be performed with careful control. If a patient is treated by a less experienced surgeon, the risk of injury to the bile ducts, bleeding, or damage to adjacent organs increases. In specialized centers, the surgery is performed frequently and routinely, often using state-of-the-art technology and clear standards. This ensures safety and a high success rate. Patients should therefore ensure that the procedure is performed by a team that regularly performs cholecystectomies and is familiar with anatomical variations. This ensures that the surgery remains what it is meant to be: a minor, safe procedure with an excellent prognosis,” emphasizes Prof. Dr. Soysal.

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• Board-certified surgeon (FMH), specializing in visceral and oncological surgery.
• Hepatobiliary expertise—focus on liver, biliary tract, and pancreatic surgery; international fellowships (UCLA, Istanbul).
• Academic Career — Senior physician positions at the University Hospital of Basel and Clarunis; Titular Professor since 2022.
• Academic Qualifications — Habilitation in 2016; research experience in St. Louis and Basel.
• International Recognition — Fellow of the American College of Surgeons (FACS) and member of leading professional societies.
• Surgery at the Center — Part of the specialized team since 2023, focusing on minimally invasive, guideline-based visceral surgery.