Bile Composition at and after Surgery in Normal Persons and Patients with Gallstones

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Abstract
The biliary lipid composition of hepatic and gallbladder bile obtained at surgery was compared in 11 patients with cholesterol gallstones and in control subjects: 10 with pigment stones and 10 without biliary disease. Indwelling T-tubes allowed daily postoperative collections of bile for two to 20 weeks in seven patients with cholesterol gallstones and 11 controls. Patients with cholesterol gallstones (a) secreted hepatic bile that was supersaturated and clearly different from that in controls at surgery; and (b) after cholecystectomy, produced bile with a composition identical to that of controls without gallstones. Thus, the gallbladder is essential for the continuous production of lithogenic hepatic bile. To define the hepatic defect further, bile-salt synthesis was determined from dependent T-tube drainage in 10 patients with cholesterol stones. Under the stimulus of an interrupted enterohepatic circulation, hepatic synthesis increased fourfold. Since synthesis can increase in response to loss, the hepatic defect appears to be in feedback inhibition and requires the presence of the gallbladder.