@Sheryl I am asking for a friend of my wife who has been told she will have to remove the gall bladder. I do not know the reason for the diagnosis at this point.

But before doing so, it may be a good idea to seek a second opinion with another doctor, to see if it can be avoided and alternative treatment can be found.

I am aware that gallbladder removal is a fairly routine and simple (usually laparoscopic) procedure, but it will be quite limiting for proper fat metabolism, so if it can be safely avoided it would be better.

So I need recommendation to a Bangkok specialist doctor in this field that is open also for other solutions before resorting to surgery.

As an aside, I was myself told 16 years ago that I had to remove the gall bladder due to something the doctor THOUGHT MAY look like a TINY gall stone on ultrasound. I refused and have never had a problem. And this was at a famous Bangkok hospital. Just sayin'...

First of all, if your friend's wife was told this at a Thai government hospital it is almost surely true. The public hospitals do not rush to operate and will indeed try other approaches first unless the stone is really large or causing blockage.

Secondly, GB removal does not limit proper fat metabolism much if at all. The metabolic pathways remain unchanged, what differs is just the amount of bile available at any one time and simply avoiding eating too much fat all at one go is usually enough. (How much is too much, is highly individual but easily figured out. It is not total fat intake that matters but the amount at one sitting).

Now, if she was told this at a private hospital, and she is asymptomatic (which you did not specify) then yes, another opinion should be sought and I would suggest to do that through the public hospital system (I am assuming she is Thai?). Try one of the Profs at Chula's after hours clinic

https://spcweb.kcmh.or.th/users/users/searchDoctor

(select Gastrointestinsal and Liver diseases, there are a number of Professors l sted).

Thank you so much @Sheryl, and sorry I didn't have more information about the patient or hospital she went to.

It may seem it was some kind of cyst, if that is even a thing in the gall bladder?

Anyway, your advice will be passed on to the patient.

10 hours ago, MeaMaximaCulpa said:

Thank you so much @Sheryl, and sorry I didn't have more information about the patient or hospital she went to.

It may seem it was some kind of cyst, if that is even a thing in the gall bladder?

Anyway, your advice will be passed on to the patient.

Gall bladder cysts are quite rare but do exist.

GB polyps would be more common than cysts. Most are benign but they can be -- or become - malignant.

It is recommended to remove GB if there is a polyp of size 1 cm or more provided it is a true polyp and not a pseudopolyp, since larger polyps are more likely to be malignant. Might also be recommended for smaller polyps if there are other risk factors present or pstient has symptomatolic GB inflammation. Cancer of GB is more common in Thais than Westerners especially those from Issan area.

Thanks again @Sheryl for that valuable information, I am sure it will be appreciated by the patient!

The mainstream medical profession can be quick to recommend the whipping out of a gallbladder. For sure, sometimes it is necessary - but there are many occasions when it is not. If the recommendation to remove it is based on gallbladder stones or gallbladder sludge, there are some alternatives that are worth trying before the irreversible surgical removal of the gallbladder.

In the case of gallbladder stones, Chanca Piedra is worth trying. It's a herbal supplement known as a stone breaker that is used to break down kidney stones, gallstones and support liver health. It is an effective treatment but it can be slow, as in it can take a few months.

If it's a case of sludge and and a congested / low-functioning gallbladder, then definitely try TUDCA. This is one of the most effective supplements prescribed by Functional Medicine Doctors and others outside of the mainstream medical profession. It has a very high success rate! I used this when my gallbladder function was low due to gallbladder sludge and doctors wanted to operate. TUDCA cleared the sludge quickly. Pairing this with Milk Thistle and a good choline supplement like Sunflower Lecithin can have an amazing effect on the gallbladder and general liver health and turn things around very quickly.

I fully support @mstevens in this. And it is unfortunately true in many other areas of medicine as well, especially with "lifestyle related diseases". Acute, trauma medicine I will not question, there I am happy to trust the docs to save my life 🙂.

The problem arises in seeing the difference; i.e. when is the "conventional" doctor correct, and when can an alternative approach perhaps be better? And is there time to explore it?

I have no definitive answer to that question except to learning as much as possible, be open to new information and at the same time very critical to where it comes from and the science it is based on.

Just to chime in if anyone needs a laparoscopic cholecystectomy, Bangkok Christian Hospital has a poster up inside stating 197,000 baht. I happened to see it during a visit last week.

14 hours ago, mstevens said:

The mainstream medical profession can be quick to recommend the whipping out of a gallbladder. For sure, sometimes it is necessary - but there are many occasions when it is not. If the recommendation to remove it is based on gallbladder stones or gallbladder sludge, there are some alternatives that are worth trying before the irreversible surgical removal of the gallbladder.

In the case of gallbladder stones, Chanca Piedra is worth trying. It's a herbal supplement known as a stone breaker that is used to break down kidney stones, gallstones and support liver health. It is an effective treatment but it can be slow, as in it can take a few months.

If it's a case of sludge and and a congested / low-functioning gallbladder, then definitely try TUDCA. This is one of the most effective supplements prescribed by Functional Medicine Doctors and others outside of the mainstream medical profession. It has a very high success rate! I used this when my gallbladder function was low due to gallbladder sludge and doctors wanted to operate. TUDCA cleared the sludge quickly. Pairing this with Milk Thistle and a good choline supplement like Sunflower Lecithin can have an amazing effect on the gallbladder and general liver health and turn things around very quickly.

In this case it appears the patient has a mass (not a stone or sludge) within the GB. So the concern is cancer of the GB, which is more common in Thais than in Westerners.

In this instance trying to avoid or delay surgery could be a serious, even life-threatening, mistake.

On 2/18/2026 at 8:13 AM, MeaMaximaCulpa said:

@Sheryl I am asking for a friend of my wife who has been told she will have to remove the gall bladder. I do not know the reason for the diagnosis at this point.

But before doing so, it may be a good idea to seek a second opinion with another doctor, to see if it can be avoided and alternative treatment can be found.

I am aware that gallbladder removal is a fairly routine and simple (usually laparoscopic) procedure, but it will be quite limiting for proper fat metabolism, so if it can be safely avoided it would be better.

So I need recommendation to a Bangkok specialist doctor in this field that is open also for other solutions before resorting to surgery.

As an aside, I was myself told 16 years ago that I had to remove the gall bladder due to something the doctor THOUGHT MAY look like a TINY gall stone on ultrasound. I refused and have never had a problem. And this was at a famous Bangkok hospital. Just sayin'...

I had my gallbladder removed because of intense pain and enjoyed instant life improving pain relief and have had no problem digesting normal amounts of fat. Previous to the surgery I tried various non-surgical treatments to no effect. I had surgery in the afternoon and was discharged the following day.

I'm glad to hear that @Poilu !

My comment on "proper fat metabolism" was referring to higher than average amounts of fat, seen when eating low carb high fat, keto or carnivore diets, where fat may go as high as 70-80% of calories.

Some people may argue against this dietary approach, and I am not saying it is for everyone. But with this kind of diet, often combined with intermittent fasting, eating one or two meals per day in a narrow eating window, will be difficult without a gall bladder to buffer the bile. On a lower fat diet with several smaller meals spread over the day, it is not much of a problem for most people.

Update @Sheryl , the patient has decided to do the GB removal soon. The decision was made based on the following: The mass had grown fairly quickly, her father had experienced cancer of the GB, and her family originates from Isaan. So too many things pointing to caution and speed to reduce the risk. Thanks for pointing all this out!

1 hour ago, MeaMaximaCulpa said:

Update @Sheryl , the patient has decided to do the GB removal soon. The decision was made based on the following: The mass had grown fairly quickly, her father had experienced cancer of the GB, and her family originates from Isaan. So too many things pointing to caution and speed to reduce the risk. Thanks for pointing all this out!

As described above , prompt surgery is very definitely indicated.

Cancer of the GB is quite serious and often carries poor prognosis.

This situation is entirely different from that of patients with gallstones (see post to follow)

Reverting to the issue of GB removal for gallstone disease (which is not the situation for the patient in question):

1. One needs to distinguish between asymptomatic and asymptomatic stones. The latter are a common incidental finding from ultrasounds and other scans (and one of many reasons why routine abdominal ultrasounds are NOT recommended as part of routine physical checkups...but quite popular with private hospitals as they find all manner of things that then lead to further tests and treatments, many of them unnecessary).

2. For people with symptomatic stones, generally surgery is advised but if the patient is a poor surgical risk, or symptoms are mild (i.e. pain is manageable, no high fever, no blockage of the common bile duct etc) , conservative measures can be tried if patient agrees. Note that CBD blockage is a serious condition that can lead to life threatening, complications and requires prompt treatment. Conservative measures would include diet, medications to help dissolve stones etc.

3. For asymptomatic stones, the thinking has evolved in recent years. It needs to be understood that there are risks both ways i.e. failing to remove a stone, especially a large one, will lead to CBD blockage, pancreatitis, even death, in a small minority of people; and GB removal, while generally a safe and common surgery, will nonethless cause serious complications in a small minority of people. Looking at populations as a whole, the data overall supports not treating asymptomatic stones ("watchful waiting").

   https://www.nice.org.uk/guidance/cg188/chapter/Recommendations#managing-gallbladder-stones

   https://www.worldgastroenterology.org/guidelines/asymptomatic-gallstone-disease/asymptomatic-gallstone-disease-english

   Nonethless, in certain specific individual cases, a surgeon might advise treatment for asymptomatic stones, for example if the patient lives or will be travelling somewhere far from medical facilities. Some surgeons may also advise this if the stone is large and the patient elderly or frail, on the rationale that there is more than average risk of CHD blockage and the patient is at elevated risk of death if such occurs. But in most cases, asymptomatic stones should be left as is.

19 hours ago, MeaMaximaCulpa said:

I'm glad to hear that @Poilu !

My comment on "proper fat metabolism" was referring to higher than average amounts of fat, seen when eating low carb high fat, keto or carnivore diets, where fat may go as high as 70-80% of calories.

Some people may argue against this dietary approach, and I am not saying it is for everyone. But with this kind of diet, often combined with intermittent fasting, eating one or two meals per day in a narrow eating window, will be difficult without a gall bladder to buffer the bile. On a lower fat diet with several smaller meals spread over the day, it is not much of a problem for most people.

Update @Sheryl , the patient has decided to do the GB removal soon. The decision was made based on the following: The mass had grown fairly quickly, her father had experienced cancer of the GB, and her family originates from Isaan. So too many things pointing to caution and speed to reduce the risk. Thanks for pointing all this out!

I was just trying to reassure the lady if she opted for surgery.

@Poilu I appreciate that, I just wanted to give a bit more background for my position on fat metabolism, and thought it was a good opportunity.

I don't want to pick a fight over this with anyone, since we are all different both in physiology and preferences.

So all good! 🙂

Removed mine, happy with it. And what really amazed me was that there wasn't any recovery. Admitted a 7am, enjoying a blueberry cheesecake at 3pm the next day. Had fish for lunch though.

Always get your own copies of x-rays and MRI. Then you can easily get second opinions from multiple doctors if you feel the need.