Archive for month: July, 2018

This is an open letter to the Southern Cross Healthcare Group, the Southern Cross CEO and Board of Directors to increase awareness and provide evidence of New Zealand’s largest on-going medical fraud and malpractice – laparoscopic cholecystectomy surgery – for the treatment of gallstones and gallbladder problems. We raise issues pertaining to the misconduct of New Zealand laparoscopic cholecystectomy surgeons operating through Southern Cross services. Their practices are illegal and in a direct violation of the Code of Health and Disability Services Consumers’ Rights. Many Southern Cross members (patients) are being harmed and defrauded of their health and wellbeing and put at risk of serious health complications as a result of surgical treatment. There is also consistent blocking of post care treatment support for patients of laparoscopic cholecystectomy in order to maintain the deception. Southern Cross patients’ are left on their own to battle debilitating health complications that according to laparoscopic cholecystectomy surgeons do not exist.

This letter is also a follow up to a member’s complaint and warnings that was ignored. We present significant and credible evidence of medical studies and patient testimonies confirming medical malpractice. Every consent for cholecystectomy treatment conducted through Southern Cross health services is being obtained illegally.

Detail in the complaint clearly identified a breach of patients’ legally enforceable rights and should have triggered a risk and patient safety compliance review when first advised. In our view, Southern Cross Healthcare group had an ethical, moral and legal duty to respond promptly to this complaint.

We are a patient advocacy project established by victims of medical fraud, to promote the protection of the legal and ethical rights of health consumers, and Southern Cross society members, which include but are not limited to:

• The right to be protected from exploitation and medical malpractice, including fraudulent behaviour to obtain informed consent, inflicting cruel, inhumane and degrading treatment on patients; and
• The legal right to give informed consent, also known as the patient right to autonomy,
• The right to have services provided in a legal and ethical manner, free from exploitation and coercion, to minimise the potential harm to patients and optimise their quality of life; and
• The right to post-treatment care support for when known health complications establish, or chronic illnesses arise that diminish patients’ quality of life.

The Implication of Southern Cross Healthcare Group – Direct involvement and accessory to patient fraud

Some years ago Southern Cross was advised through a formal patient complaint that laparoscopic cholecystectomy surgeons accessing services and operating through your private hospital facilities were harming patients. Specifically:

1. New Zealand laparoscopic cholecystectomy surgeons are refusing to disclose and acknowledge treatment side effect complication risks and failing to offer non-surgical treatment options alternatives when seeking treatment of gallstones and gallbladder problems or related pain. This is occurring despite patients giving their surgeon consent provided only on the basis that no side-effect complications are likely to affect their on-going health and wellbeing; (this is also known as a “ Heath Directive” given by patient for any treatments) and despite repeated requests for information about long-term health complications. The response of surgeons’ is that their patients can live a normal life and no side effects exist or disclosed.
2. New Zealand laparoscopic cholecystectomy surgeons are refusing to acknowledge the existence of Postcholecystectomy Syndrome (PCS) that is supported by a well-recognised body of evidence-based medical opinion as being a heterogeneous group of diseases and symptoms presenting following gallbladder removal.
3. New Zealand laparoscopic cholecystectomy surgeons are refusing to provide post care support, or any information needed to manage post-surgery complications that eventuate.

The problem faced by Southern Cross Society members in more detail:

Gallbladder surgery (cholecystectomy) for treatment of gallstones is being carried out through Southern Cross Hospital services in a manner that is illegal and compromising the safety of patients, and also compromising their legally enforceable rights, under the HDC Code of Rights. A laparoscopic cholecystectomy surgery is promoted as the only option for patients and is presented as a mandatory option – or the alternative is to simply do nothing to help patients. (Surgeons call this “watchful waiting”)  Effectively, this has been guaranteeing revenue for surgeons, at a future stage, when patients have no option but to take the surgical route as a course of action.

In order to obtain consent for laparoscopic cholecystectomy New Zealand surgeons are openly lying to patients. Surgical treatment is currently presented as having no lasting side effects and patients are led to believe that they can live a normal life, return to a normal diet and will not have the risk of digestive problems after gallbladder removal.  There is currently no disclosure of side effects risks affecting quality life, or the provision of available alternative non-surgical treatment options. The only option left for patients, apart from surgery, is to do nothing. Hence, in most situations patients take the surgical route to try and improve their health.

There is no investigation into a patient’s underlining condition taking place to accurately assess any health problems in order to provide the right course of treatment. Confirming the presence of a gallstone through ultrasound and having pain in the gallbladder is the only likely investigation a surgeon currently needs to justify the removal of a patient’s gallbladder.  (Surgeons call this the ‘gold standard’ for treating problems and is backed by the HDC rulings). This is described as medical rape and coercion by some patients

In order to maintain the fraud, when well-documented side effects become established and detrimentally affect patient health, surgeons have taken extraordinary steps to ensure that post-surgery complications are not diagnosed and treatment support is not provided to patients. Correct diagnosis and treatment of complications would contradict surgeons’ claims made to patients. The deliberate prevention of post medical support is also called medical torture

DHB’s are most unlikely to provide any access to medical services that could be used to provide a diagnosis for treatment. Furthermore, any diagnosis would confirm an omission of the truth and could be used in a court of law to confirm a criminal offence has occurred by their employees (surgeons)

Southern Cross have advises members seeking support that post-surgical treatment and care is not covered under their membership policy and that ACC has a statutory obligation to provide support. Unfortunately, the same surgeons operating through Southern Cross are also asked to provide input in a clinical assessment for ACC and block any support to protect their income stream and insist patients’ health complications arising Postcholecystectomy are not a result of treatment. This is called unethical lying to maintain a deception

Any patient seeking protection of their legal rights under the HDC Act, soon discover the HDC is in fact an ‘illegal construct’ established to protect medical practitioners and block health consumer complaints, rather than carry out its intended statutory function to protect the rights of health consumers through the HDC Code of Rights.  The HDC accept the opinion of laparoscopic cholecystectomy surgeons to be true, honest, transparent and factual despite their own internal advisors confirming there is a misrepresentation of truth undisclosed to patients about the side effect risks. Furthermore, correct diagnosis procedures for surgery treatment is not being followed, confirming fraud and a breach of rights.

New Zealand laparoscopic cholecystectomy surgeons are presenting the HDC ruling stating in patient clinical support investigations, complications developed Postcholecystectomy are argued not to be a result or side effects of surgical treatment and the removal of the gallbladder function. Surgeons believe this have sufficiently covered off any requirement for clinical assessments for treatment into a patients health post cholecystectomy by saying “the HDC has addressed in full” “there is no breach of patient rights taking place”. As a result, there are few further options available for patients to obtain a resolution for treatment support. This is because surgeons have an influence on treatment services provided through DHBs and they also support the justification for treatment (no side effect problems exist). In effect, Southern Cross members are being blocked from receiving post-care treatment support, medical advice, or access to services. There is a complete inability for patients to receive a clinical diagnosis of what is going wrong through their DHB.

The only remaining definitive option left for patients to confirm treatment support is needed for post-surgery complications (chronic, debilitating or otherwise) would be to obtain a private pathologist autopsy report presented to the only remaining independent (non-protective) service for investigation, The New Zealand Coroner.

Here is a list of common misrepresented claims New Zealand surgeons make to patients in order to obtain illegal consent and presented to HDC and also in clinical assessments for post treatment support:

• The gallbladder is an unnecessary vestigial organ (prehistoric) not needed • There is no treatment or diet that can prevent or treat gallstones • A gallbladder containing gallstones by medical definition is diseased; and then stating the only safe treatment is to remove the gallbladder  • You don’t need a gallbladder to digest food properly
• You can live a normal life without a gallbladder • Digestion continues as normal • No likely side effects
• Surgery is the only treatment option for gallstones • Removal of the gallbladder is generally considered to have no lasting consequences  • There is no adverse effect on the gut’s ability to metabolise fat (no effect on the digestive tract’s ability to break down ingested fats into essential fatty acids and glycerol)

 (See 100K-reward for further details on opinions presented to Patients, the HDC and ACC) https://hdcfraud.com/100k-reward/

Summary Southern Cross member rights routinely breached:

• Right to have services provided in a manner that minimises the potential harm to, and optimises the quality of life, of that consumer
• Right to services provided that comply in a legal, professional and ethical manner, without coercion or exploitation
• Right to be treated with respect. (Failure to disclose planned harm outcomes involves tacit deception, in breach of medical ethics four moral principles of autonomy, beneficence, non-maleficence and justice)
• Right to make an informed choice without deception and concealment of side effect risks or alternative treatment options

Southern Cross Board of Directors are legally responsible for the safety of their members

Both public and private hospitals (including Southern Cross Health) are subject to the duties imposed on healthcare providers by the Code of Health and Disability Services Consumers’ Rights, in particular, the duty to provide services that comply with legal, professional, ethical, and other relevant standards (Right 4(2); and patients’ right to have services provided in a manner that minimises the potential harm to, and optimises their quality of life of (Right 4(4))

There is a duty of care for hospitals to ensure practitioners are competent to practise and the need to protect patients is also recognised in common law (see Roylance v General Medical Council [1999] 3 WLR 541). The Privy Council stated, “The care, treatment and safety of the patient must be the principal concern of everyone engaged in the hospital service.”  (HDC decisions/04hdc07920)

Services may be provided to a health consumer only if that consumer makes an informed choice and gives informed consent, except where any enactment, or the common law, or any other provision of the Code of Rights provides otherwise. Without this information, patients are denied the opportunity to legally give informed consent.

To confirm Southern Cross patients’ legal rights are being breached, the following would to be internally investigated:

Task 1: Review the obtain and review Southern Cross members patient information handout and informed consent documentation used to obtain consent for laparoscopic cholecystectomy surgery and confirm it is void of any side effect risks and alternative non-surgical treatment options required to be presented to patients. This is fraud by false representation and is also a criminal offence under the Crimes Act 1961 No 43 (as at 28 September 2017), Public Act 240.  Evidence to review include :

• Southern Cross patient information handouts, absent of alternative treatment options or side effect risks (link) https://www.southerncross.co.nz/group/medical-library/gallstones-causes-symptoms-treatment
• New Zealand surgeons gold standard patient consent from  https://hdcfraud.com/fake-informed-consent-documentation-presented-by-nearly-every-district-health-board-dhb/

As you are aware, doctors, surgeons and Southern Cross has a duty of care to warn patients of the material risks of treatment for laparoscopic cholecystectomy – including informing patients of the risks of a heterogeneous group of diseases and symptoms presenting as side effects that can be transient, persistent, lifelong and chronic. These documents do not meet this requirement.

“If it can be shown that a doctor has failed to provide adequate information and thereby failed to ensure that the patient comprehends, so far as is possible, the factors required to make decisions about medical procedures, such failure could be considered medical misconduct and could be the subject of disciplinary proceedings” The Medical Council of New Zealand

Task 2: Contact and interview Southern Cross patients, past and present that have undergone cholecystectomy treatment to confirm whether consent was legally obtained and whether the patient was given an opportunity to make and provide informed consent. Also, ask for a copy of their signed consent documentation for review.

 

1. Were Southern Cross patients advised of the side effect risks of a heterogeneous group of diseases and symptoms that can present in up to 40 per cent of patient who undergo cholecystectomy? Symptoms can be transient, persistent, lifelong and chronic. Chronic conditions are diagnosed in approximately 10% of postcholecystectomy cases.

NB: It also displays an immoral, unethical and illegal intent to inflict patients with a heterogeneous group of diseases and symptoms presenting following gallbladder removal. Under Section 201, of Crimes Act 1961 this is identified as infecting with disease, and everyone is liable to imprisonment for a term not exceeding 14 years who, wilfully and without lawful justification (patient consent obtained illegally), or excuse, causes or produces in any other person any disease or sickness.

 

2. Were Southern Cross patients offered and or advised of non-surgical alternative treatment options?

 

3. Is post-treatment care support being provided for those affected with Postcholecystectomy side effects?

 

4. Was information provided to patients to help mitigate, diagnose and treat side effect risks, in order to minimise the potential harm, and optimise quality of life?

 

5. Carry out an analysis of medical records of Southern Cross patients who have undergone laparoscopic cholecystectomy to confirm the extent (increased utilisation most likely referred by multiple treating private practice Gastroenterologists – due services blocked by HDB’s) of services used in diagnosing or treating post surgery complications. Confirm whether a diagnosis for treating post surgery complications was received, not exploited and also, whether services are being provided in a manner that minimises the potential harm arising from complications.

 

 

Task 3: Confirm the opinions of laparoscopic cholecystectomy surgeons presented to Southern Cross patients are true, honest and transparent:

1. Meet with experienced Gastroenterologists and ask of them, “Who is telling the truth about long-term risks? What information offers informed consent?”
2. Meet with an experienced Naturopathic physician and seek out their opinions on the current state of cholecystectomy patients seeking support for post side effect complications and confirm many are blocked or left with no treatment provided or post surgery support.

In addition, upon further investigation you will quickly discover the following:

• Patients are being isolated to accept surgical opinion for treatment. There is no option for the patient to discuss their situation with a gastroenterologist or even a holistic doctor (who have been known to openly criticise and disagree with New Zealand surgeons’ willingness to operate). Surgery is presented as a one-stop treatment and patients are led to believe that side effects do not exist. As a result the likelihood of receiving an honest disclosure is slim to none.
• You will also find, there is no evidence-based medical study known backing many of the claims presented to patients in order to obtain consent. These definitive claims are nothing more than dishonest, delusional revenue-based fantasies. At the very least it is fraudulent, deceitful behaviour by omitting the true risks and lying to patients. Furthermore, sending a patient home without the support needed to mitigate or manage the onset of well-documented post surgery problems is an intent to commit grievous body harm and can cause serious health complications that can be both chronic and life long.
• You will also find, New Zealand laparoscopic surgeons have always lied to patients. Surgeons called this ‘cholecystectomy surviving the treat from alternate treatment options in the 80’s’ where procedures were decreasing steadily.

Patient advocacy for Southern Cross Members:

In our role as a patient advocacy group, we have taken the following steps to stop the harm and obtain treatment support for cholecystectomy patients:

1. Because the likelihood of patients being contacted by public or private hospitals to ensure patients are receiving support would be unlikely (cover-up rather than risk exposure), using a variety of mediums, including print and media outlets, to expose treatment conducted illegally and patents are at risk of harm from . Furthermore, we intend to expose the proliferation of misinformation and falsities about the risk of certain side effects, which may significantly impact patients’ quality of life. We vociferously believe that patients’ have been blocked from receiving post-care treatment support in order to cover-up culpability.

 

2. Prove, with evidence, New Zealand surgeons are lying incessantly about the surgery and treatment options and brutally harming patients by blocking post-treatment support care:
   1. We have 1500+ patient testimonies, many of which describe crippling health complications and New Zealand surgeons’ strongly deny their existence. Instead they argue the side effects are not a result of their tenement so no post-care support should be provided, despite a mounting body of evidence to the contrary.
   2. We have published examples of false, misleading and fraudulent patient information documentation used by surgeons, to illegally obtain consent through deception. There is a consistent misrepresentation of the facts that have been deliberate crafted to conceal all side effects risks and alternative non-surgical treatment options. Instead, there is a preference to utilise surgery as a treatment option purely for the financial gain of the surgeon.
   3. Prove there is existing fraud by false representation and a criminal offence occurring under the Crimes Act 1961, Section 240. (See hdcfraud.com/dhbfraud)

 

3. Prove, with evidence, the HDC is providing protection to doctors and expose their possible conspiracy to obstruct justice and their failure to identify the patient’s Code of Rights breaches. As such, the HDC could even be held liable as an accessory to resulting patient deaths:
   1. We are posting a reward (increased to $100,000) asking for proof that evidence and information provided to obtain consent is not misleading, deceptive and fraudulent (and under the protection of the HDC). (See hdcfraud.com/100k-reward)
   2. We are publishing the HDC investigations of cholecystectomy patients, exposing fraud. (See hdcfraud.com/the-protection)

 

4. Holding to account those directly responsible and those who are accessories to New Zealand’s largest medical fraud for breaching patients’ rights and causing harm, this letter is published for all to see

Further investigative reading will confirm NZ laparoscopic cholecystectomy Surgeons have always lied to patients can be found at www.hdcfraud.com

Comprehensive and reputable medical studies confirm post complications include:

The Postcholecystectomy Syndrome (PCS): is a heterogeneous group of diseases and symptoms presenting following gallbladder removal. Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy, and can be transient, persistent or lifelong. The chronic condition is diagnosed in approximately 10% of postcholecystectomy cases.

Post-cholecystectomy Syndrome may include: 

• Diarrhoeaas a troublesome problem range from 9 to 12% of which bile acid malabsorption (BAM), 65% of these patients.
• Depression, anxiety disordersoccurring in 0.9%-3.0% of patients
• Bile (duodenogastric) refluxoccurring in 20%-30% of patients.  Likely damage attributable to chronic bile exposure post-cholecystectomy includes:
  • cellular damage to esophagogastric junction
  • bile induced Gastroesophageal Mucosal Injury (Protective barrier that constrains the acidic reflux)
  • increase the incidence of gastric and esophageal cancer
• Sphincter of Oddi dysfunction (SOD) is seen in 1% of patients after cholecystectomy, but in 14%-23% of patients with the post-cholecystectomy syndrome
• increased Body Mass Index (weight gain) with metabolic syndrome, gastritis, liposoluble vitamin deficiency. Cholecystectomy can have nutritional and metabolic consequences and in the long-term

The cholecyst sphincter of Oddi reflex, cholecyst-antral reflex, and cholecyst-oesophagal reflexes are all disrupted and some local upper gastrointestinal hormonal changes also occur after cholecystectomy. Thus, there is an increased incidence of gastritis, alkaline duodene gastric reflux and gastro-oesophageal reflux after cholecystectomy, all of which may be the basis for postcholecystectomy symptoms.”

The onset of symptoms may range from 2 days to 25 years.  There may also be gender-specific risk factors for developing symptoms after cholecystectomy. In one study, the incidence of recurrent symptoms among female patients was 43%, compared to 28% of male patients.”

Postcholecystectomy Syndrome in more detail

Absence of the gallbladder leads to development of functional biliary hypertension and dilatation of common bile duct and the common hepatic duct. The dilatation of right and left hepatic ducts may be formed within 3-5 years after cholecystectomy. Functional hypertension in the common bile duct leads to development of functional hypertension in Wirsung’s pancreatic duct accompanied by chronic pancreatitis symptoms.

During this period in some patients this is accompanied by chronic pancreatitis progression, dysfunction of the sphincter of Oddi and duodeno-gastral reflux. Duodeno-gastral reflux causes the development of atrophic (bile-acid-depen­dent) antral gastritis . After cholecystectomy 40% to 60% of patients suffer from dyspeptic disorders, 5% to 40% from pains of different localizations. Up to 70% of patients show symptoms of chronic “bland” intrahepatic cholestasis, chronic cholestatic hepatitis and compensatory bile-acid-dependent apoptosis of hepatocytes. In some of cholecystectomized patients with high concentration of hydrophobic hepatotoxic co-cancerogenic deoxycholic bile acid in serum and/or feces high risk of the colon cancer is found.

Not disclosed to patients, specialist medical opinion and studies list the following expected risks, side effects, diseases, syndromes and conditions after the removal of the gallbladder and its function. The majority of these problems are not accepted by the HDC as a risk and are blocked from disclosure to patients during the informed consent process, or advised during post-operative follow-ups.

They are but not exclusive to:

Anatomy	Etiology
Biliary track	Biliary injury Cholangitis Choledochoduodenal fistula Choledocholithiasis Clip migration / Inaccurate clip placement Dyskinesia Nonspecific dilatation or hypertension Obstruction Strictures Stump cholelithiasis Adhesions Cyst Dilation without obstruction Fistula Hypertension or nonspecific dilation Malignancy and cholangiocarcinoma Trauma
Bone	Arthritis
Colon	Adhesions; incisional hernia; irritable bowel diseaseConstipationDiarrhoea Incisional hernia
Duodenum	AdhesionsDuodenal diverticulaIrritable bowel disease Peptic ulcer disease Perforation
Esophagus	AchalasiaAerophagiaDiaphragmatic hernia Esophagitis Hiatal hernia
Gallbladder and cystic Duct remnant	InflammationLeakMirizzi’s syndrome Mucocele Neuroma (Amputation ), suture granuloma Residual or reformed gallbladder Stump cholelithiasis
Liver	Chronic idiopathic jaundiceCirrhosisCyst Dubin-Johnson syndrome Fatty liver; hepatitis; cirrhosis; idiopathic jaundice Gilbert disease Hepatitis Hydrohepatosis Liver abscess Sclerosing cholangitis
Nerve	Intercostal lesionsIntercostal neuralgiaNeuroma Neurosis Psychic tension or anxiety Spinal nerve lesions Sympathetic imbalance
Pancreas	Benign tumorsFunctional pancreatic sphincter disorderPancreatic cysts Pancreatic stone Pancreatitis Stone Tumors
Periampullary	PapillomaSphincter of Oddi dysfunction (Functional biliary sphincter disorder); spasm; hypertrophyspasm; hypertrophySphincter of Oddi stricture Stricture
Small bowel	AdhesionsAdhesions; incisional hernia; irritable bowel diseaseIncisional hernia Irritable bowel disease
Stomach	Bile gastritisPeptic ulcer disease
Subcutaneous tissue	AbscessHematoma
Vascular	Coronary anginaInjury to hepatic artery, portal vein (pseudoaneurysm, portal vein thrombosis)Intestinal angina Mesenteric ischemia
Miscellaneous	Dropped GallstonesParasitic infestation (Ascariasis)Thermal injury Trocar site hernia
Other	AnxietyBacteria overgrowth in the stomachBarrett’s oesophagusBezoars Bile Acid Malabsorption Bile Reflux Bloating Celiac Disease Cramps Decrease in bile secretion Depression Diabetes Dumping of bile Syndrome Foreign bodies, including gallstones and surgical clips Gas Gastroparesis GERD Reflux Heartburn Irritable Bowel Syndrome Nausea Pain – right upper abdomen Pain – shoulders and abdomen Thyrotoxicosis Weight gain Weight loss

Evidence based medical studies confirming statistically significant increased risk of cancer following cholecystectomy, required by law but never disclosed by doctors during the informed consent process listed as:

Anatomy	Etiology
Other Biliary tract Liver Colon Esophagus Stomach Liver Liver Pancreas Periampullary Other	Adrenal cancer Ampulla of Vater cancer Cholangiocarcinoma cancer Colorectal cancer (Colon / Bowl) Esophageal cancer Gastric cancer Hepatocellular carcinoma cancer Liver cancers Pancreatic cancer Periampullary cancer Smallintestine carcinoid cancer

Source references:

1. M. Farahmandfar, M. Chabok, M. Alade, A. Bouhelal and B. Patel, Post Cholecystectomy Diarrhoea—A Systematic Review, Surgical Science, Vol. 3 No. 6, 2012, pp. 332-338. http://dx.doi.org/10.4236/ss.2012.36065
2. Tsai M-C, Chen C-H, Lee H-C, Lin H-C, Lee C-Z (2015) Increased Risk of Depressive Disorder following Cholecystectomy for Gallstones. PLoS ONE 10(6): e0129962. https://doi.org/10.1371/journal.pone.0129962
3. Nudo R, Pasta V, Monti M, Vergine M, Picardi N. Correlation between post-cholecystectomy syndrome and biliary reflux gastritis. Endoscopic study. https://www.ncbi.nlm.nih.gov/pubmed/2699712
4. Lorusso D1, Pezzolla F, Montesani C, Giorgio P, Caruso ML, Cavallini A, Guerra V, Misciagna G. Duodenogastric reflux and gastric histology after cholecystectomy with or without sphincteroplasty https://www.ncbi.nlm.nih.gov/pubmed/2253017
5. Shah Gilani SN1, Bass GA1, Kharytaniuk N2, Downes MR3, Caffrey EF3, Tobbia I3, Walsh TN4. Gastroesophageal Mucosal Injury after Cholecystectomy: An Indication for Surveillance? https://doi.org/10.1016/j.jamcollsurg.2016.12.003
6. Bistritz, L., & Bain, V. G. (2006). Sphincter of Oddi dysfunction: Managing the patient with chronic biliary pain. World Journal of Gastroenterology : WJG, 12(24), 3793–3802. http://doi.org/10.3748/wjg.v12.i24.3793
7. Donato F. Altomare, Maria T. Rotelli, Nicola Palasciano. Diet After Cholecystectomyhttp://www.eurekaselect.com/node/152535/article
8. Wikipedia,  Postcholecystectomy syndrome.  https://en.wikipedia.org/wiki/Postcholecystectomy_syndrome
9. Steen W Jensen, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF Postcholecystectomy Syndrome [medscape.com]
10. S.S.JaunooS MohandasL.M.Almond. Postcholecystectomy syndrome (PCS) [ScienceDirect]
11. Sureka B, Mukund A. Review of imaging in post-laparoscopy cholecystectomy complications. Indian J Radiol Imaging 2017;27:470-81  [Indian Journal of Radiology and Imaging]
12. Murshid KR. The postcholecystectomy syndrome: A review. Saudi J Gastroenterol [serial online] 1996 [cited 2018 Jan 15];2:124-37. Available from:  http://www.saudijgastro.com/text.asp?1996/2/3/124/34017
13. Girometti, R., Brondani, G., Cereser, L., Como, G., Del Pin, M., Bazzocchi, M., & Zuiani, C. (2010). Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography. [The British Journal of Radiology, 83(988), 351–361]
14. Jacob L. Turumin, Victor A. Shanturov, Helena E. Turumina. Irkutsk Institute of Surgery, Irkutsk Regional Hospital, Irkutsk 664079. The role of the gallbladder in human [ScienceDirect]
15. Dr. Jacob L. Turumin, MD, PhD, DMSci Biliary Diseases Laparoscopic Cholecystectomy. Postcholecystectomy Syndrome. http://www.drturumin.com/en/index.html#sthash.Y35Uey8C.dpuf
16. Martin, Walton. “RECENT CONTROVERSIAL QUESTIONS IN GALL-BLADDER SURGERY.” Annals of Surgery 79.3 (1924): 424–443. Print. [PMC]
17. The NIDDK Gastroparesis Clinical Research Consortium (GpCRC). “Cholecystectomy and Clinical Presentations of Gastroparesis.” Digestive diseases and sciences 58.4 (2013): 1062–1073. [PMC]
18. Yong Zhang , Hao Liu , Li Li , Min Ai , Zheng Gong, Yong He, Yunlong Dong, Shuanglan Xu, Jun Wang , Bo Jin, Jianping Liu, Zhaowei Teng Cholecystectomy can increase the risk of colorectal cancer: A meta-analysis of 10 cohort studies Published: August 3, 2017 https://doi.org/10.1371/journal.pone.0181852
19. Mearin, F., De Ribot, X., Balboa, A. Duodenogastric bile reflux and gastrointestinal motility in pathogenesis of functional dyspepsia. Role of cholecystectomy.  Digest Dis Sci (1995) 40: 1703. https://doi.org/10.1007/BF02212691
20. Simona Manea, Georgeta & Carol, Stanciu. (2008). DUODENOGASTROESOPHAGEAL REFLUX AFTER CHOLECYSTECTOMY. Jurnalul de Chirurgie. 4 [Researchgate]

Another opinion not accepted by NZ Laparoscopic Surgeons or heath consumer watch dog Health and Disability Commissioner and as such never presented to patients when legally obtaining informed consent for gallbladder surgery (Cholecystectomy)

The body is permanently damaged and cannot be healthy without a gallbladder and its function. You can live, but in many cases you will be miserable. Some common side effects of gallbladder removal are an upset stomach, nausea, and vomiting. Gas, bloating, and diarrhoea. Persistent pain in the upper right abdomen.

It is gross medical negligence to send a patient home after surgery and pretend there are no side effects and can lead a perfectly normal life without a gallbladder and its purpose. Due to the considerable numbers of affected New Zealand patients, under United Nations Universal Declaration of Human Rights, Article 5 and 25 an ongoing crime is occurring.

Article 5: No one shall be subjected to cruel, inhuman or degrading treatment

Article 25: Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, or other lack of livelihood in circumstances beyond his control.

Most patients suffer permanent impairments of the digestive system as a consequence of cholecystectomy, and develop various disorders as a result of poor digestion. The gall bladder is a vital organ with a crucial role in the absorption of fat and fat-soluble vitamins A, D, E and K and in essential fatty acids (omega-3 and omega-6), and poor cholesterol metabolism. In the long run, this may contribute to fatty liver. The absence of the gall bladder affects not only the process of food digestion but a wide range of other internal processes as well. In time, patients who have suffered cholecystectomy are also exposed to a high risk of developing heart disease, diabetes and disorders of the nervous system. This is due to inappropriate synthesis and assimilation of vital nutrients, vitamins and minerals.

Vitamin deficiency	Symptoms and Conditions
Vitamin A deficiency signs include	Dry eyes Drying, scaling, and follicular thickening of the skin Night blindness Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks) Respiratory infections
Vitamin D deficiency linked to a strikingly diverse array of common chronic diseases, including:	Alzheimer’s disease Asthma Autism Cancer Cavities Cold and fly Crohn’s disease Cystic fibrosis Diabetes 1 and 2 Dementia Depression Eczema & Psoriasis Hearing loss Hypertension Heart disease Infertility Inflammatory Bowel Disease Insomnia Macular degeneration Migraines Multiple Sclerosis Muscle pain Obesity Osteoporosis Periodontal disease Preeclampsia Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks) Rheumatoid arthritis Septicemia Seizures Schizophrenia Signs of aging Tuberculosis
Vitamin E deficiency signs include:	asthma and allergies brain damage cancer cognitive decline high oxidized LDL cholesterol levels hot flashes menstrual pain poor circulation prostate and breast cancers
Vitamin K deficiency can lead to:	Arterial calcification Cardiovascular disease Dementia Infectious diseases such as pneumonia Leukemia Liver cancer Lung cancer Osteoporosis Prostate cancer Tooth decay Varicose veins
Deficiencies in essential fatty acids	Allergies Alzheimer’s disease Asthma Bone weakness Brittle or soft nails Cancer Cracked skin on heals or fingertips Dandruff or dry hair Dry eyes Dry Eye Syndrome Dry, flaky skin, alligator skin, or “chicken skin” on backs of arms Fatigue Frequent urination or excessive thirst Gallstones Heart disease Lowered immunity, frequent infections Lupus erythematosus and other autoimmune diseases Multiple sclerosis Parkinson’s disease Peripheral artery disease Poor attention span, hyperactivity, or irritability Poor mood Poor wound healing Postpartum depression Premature birth Problems learning Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks) Rheumatoid arthritis Schizophrenia Tissues and organ inflammation Ulcerative colitis Vascular complications from type 2 diabetes

Source references:

1. National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. https://doi.org/10.17226/1222. https://www.nap.edu/read/1222/chapter/14#317
2. Mike Adams. What conventional medicine won’t dare tell you about gall bladder removal surgery. http://www.naturalnews.com/007733_gall_bladder_surgery.html
3. Barbara Bolen, PhD. Emmy Ludwig, MD. What to Do About IBS After Gallbladder Removal. http://ibs.about.com/od/relatedconditions/a/IBS-After-Gallbladder-Removal.htm