From the Guidelines
No, having your gallbladder removed (cholecystectomy) typically does not cause elevated alkaline phosphatase (ALP) levels several years after surgery. If you're experiencing elevated ALP levels years after gallbladder removal, this likely indicates a different underlying issue that requires medical evaluation. While ALP can temporarily increase immediately after gallbladder surgery due to the body's healing response, these levels normally return to normal within weeks. Persistently elevated ALP years later suggests other potential causes such as liver disease, bone disorders, certain medications, or bile duct problems. Common causes include primary biliary cholangitis, primary sclerosing cholangitis, medication side effects, bone disorders like Paget's disease, or bile duct strictures 1.
Some key points to consider when evaluating elevated ALP levels include:
- ALP is produced mainly in the liver and is present in the canalicular membrane of the hepatocyte (the biliary epithelium) 1
- Elevation of ALP is nonspecific and can occur in a variety of conditions affecting the liver, including cirrhosis, chronic hepatitis, viral hepatitis, congestive heart failure (hepatic congestion), and ischemic cholangiopathy 1
- Measurements of GGT can indicate whether pathologically elevated ALP is of hepatic or nonhepatic origin 1
- If the liver is suspected to be the source of elevated ALP, together with a review of the patient’s clinical history and medications, imaging of the biliary tree may be necessary to determine the etiology of extrahepatic or intrahepatic cholestasis 1
If you've had your gallbladder removed and now have elevated ALP, it's essential to consult with your healthcare provider for proper evaluation, which may include additional blood tests, imaging studies, or referral to a gastroenterologist or hepatologist to determine the actual cause of your elevated ALP levels 1. The diagnostic approach to cholestasis, which may involve elevated ALP, includes identifying the underlying cause of the impairment of bile formation and/or bile flow, and may involve classification as intrahepatic or extrahepatic cholestasis 1.
From the Research
Alkaline Phosphatase Levels After Gallbladder Removal
- The available studies do not directly address the long-term effects of gallbladder removal on alkaline phosphatase levels several years after surgery 2, 3, 4, 5, 6.
- However, a study on liver function tests after biliary-enteric anastomosis for biliary injury repair found that moderate alkaline phosphatase elevations are common in patients with excellent postoperative results, and these values tend to decrease over time 5.
- Another study compared liver function tests after laparoscopic cholecystectomy and open cholecystectomy, and found that alkaline phosphatase levels showed a slight fall after 24 hours of surgery and then a slight rise after 72 hours, but remained within normal limits 3.
- A study on the resolution of liver function tests after laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography found no significant change in alkaline phosphatase levels after laparoscopic common bile duct exploration 6.
Clinical Significance
- The studies suggest that changes in liver function tests, including alkaline phosphatase, after gallbladder removal are usually transient and clinically silent in patients with normal liver function 2, 3, 4.
- However, moderate alkaline phosphatase elevations can be a normal finding in patients after biliary-enteric anastomosis for biliary injury repair, and should not be taken as evidence of liver or anastomotic dysfunction 5.