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Post-cholecystectomy syndrome (PCS) is a complex variety of symptoms which consists of upper abdominal pain and dyspepsia, recurring and or after cholecystectomy (removal of gallbladder). It also marked with biliary and non-biliary disorders which may not be related to cholecystectomy. Early post-operative period symptoms include upset stomach, nausea, vomiting, gas, bloating, and diarrhea[1]. Late post- operative period symptoms normally caused by inflammatory scarring structures of sphincter of Oddi (SO)or bile duct, recurrent calculi or biliary dyskinesia[1].

About 5 to 40 percent of cholecystectomy patients have symptoms which can be transient, persistent or lifelong. Chornic diarrhea can be noticed in patients due to a type bile acid diarrhea and can be treated with bile acid sequestrant like cholestyramine or colesevelam[3]. In PCS patients, diet modification such as low fat diet, may help in reducing the symptoms[4].

Mechanisms

PCS can begin soon after cholecystectomy or decades later. In PCS patients with mild gastroduodenal symptoms, alteration in bile flow is the cause. However, the pathophysiology of PCS due to the changes in bile flow still remains poorly understood[2]. Spincter of Oddi dysfunction is another reason for abdominal pain in PCS patients[5].

Symptoms

Symptoms of postcholecystectomy includes stomach upset, nausea, vomiting, gas trouble, bloating, diarrhea and continuous pain in the upper right portion of the abdomen. The symptoms may be a continuation of the troubles that were caused by gallbladder or it could be developed after cholecystectomy. Due to the loss of the reservoir function of the gallbladder, there are changes in the bile flow and it could lead either into esophagitis and gastritis in the upper gastrointestinal tractor in the lower gastrointestinal tract it may result abdominal pain and diarrhea. Early symptoms start immediately after the removal of gallbladder and late PSC starts after decades of the surgery.

Diagnosis

Diagnosis for postcholecystectomy can be done through an ultrasound of the abdominal cavity, general and biochemical blood test and intravenous cholangiography. For the examination of the stomach, duodenum, and major area of the duodenal papilla an Esophagogastroduodenoscopy can be done. Retrograde cholangiopancreatography test can be done for the examination pancreases also, for the analysis of the biliary sludge an endoscopic retrograde cholangiopancreatography (ERCP) can be performed. Laproscopic cholecystectomy shows lesser post symptoms than open surgery. Bile duct balloon sweeps are performed to find abnormalities in patients who have undergone endoscopic treatment for postcholeocystectomy bile duct leakage[6]. Magnetic resonance cholangiopancreatography is a new diagnostic tool to find biliary disorders.

Treatment and Prognosis

Pain killers (explanation later). Patients do have normal life expectancy. (explanation later).

Recent Research

100 cholecystectomic surgeries using the da Vinci Surgical system shows less complications of the gallbladder removal surgery, meaning, they have less infection, less pain and fast recovery[7]. (Will elaborate on recent research). Recent studies show cholecystectomy have an altered risk of pancreatic cancer[8].

Reference

[2] [3] [4] [5] [6] [7] [8] [9]

  1. ^ 1
  2. ^ Girometti, R. "Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography".
  3. ^ Jensen, Steen. "Postcholecystectomy Syndrome;Pathophysiology".
  4. ^ Odunsi-Shiyanbade, Suwebatu. "Effects of chenodeoxycholate and a bile acid sequestrant, colesevelam, on intestinal transit and bowel function".
  5. ^ "Postcholecystectomy syndrome".
  6. ^ Madácsy, László. "Characterization of functional biliary pain and dyspeptic symptoms in patients with sphincter of Oddi dysfunction: Effect of papillotomy".
  7. ^ "Postcholecystectomy Syndrome;Background".
  8. ^ "Sinai Hospital surgeon completes 100th gallbladder procedure using da Vinci Surgical System".
  9. ^ "Cholecystectomy, gallstones, tonsillectomy, and pancreatic cancer risk: a population-based case-control study in minnesota".
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