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Post Cholecystectomy Symptoms

Abstract

Most patients do well after cholecystectomy for symptomatic gallbladder disease. Early postoperative complications are important to recognise (Table 15.1) and are discussed in Chaps. 16, 22 and 23. The main focus of this chapter is the assessment of the patient who returns to the surgeon with new or persistent symptoms, a month or later following cholecystectomy.

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Fig. 15.1
Fig. 15.2
Fig. 15.3
Fig. 15.4
Fig. 15.5
Fig. 15.6
Fig. 15.7
Fig. 15.8

Change history

References

  1. Berger MY, Olde Hartman TC, Bohnen AM. Abdominal symptoms: do they disappear after cholecystectomy? Surg Endosc. 2003;17:1723–8.

    CAS  CrossRef  Google Scholar 

  2. Peterli R, Schuppisser JP, Herzog U, Ackermann C, Tondelli PE. Prevalence of postcholecystectomy symptoms: long-term outcome after open versus laparoscopic cholecystectomy. World J Surg. 2014;24:1232–5.

    CrossRef  Google Scholar 

  3. Vander-Velpen GC, Shim SM, Cushieri A. Outcome after cholecystectomy for symptomatic gall stone disease and effect of surgical access: laparoscopic v open approach.—ProQuest. Gut. 1993;34:1448–51.

    CAS  CrossRef  Google Scholar 

  4. Schofer JM. Biliary causes of postcholecystectomy syndrome. J Emerg Med. 2010;39:406–10.

    CrossRef  Google Scholar 

  5. Farzaei MH, Bahramsoltani R, Abdollahi M, Rahimi R. The role of visceral hypersensitivity in irritable bowel syndrome: pharmacological targets and novel treatments. J Neurogastroenterol Motil. 2016;22:558–74.

    CrossRef  Google Scholar 

  6. Lamberts MP, Lugtenberg M, Rovers MM, Roukema AJ, Drenth JPH, Westert GP, et al. Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness. Surg Endosc. 2013;27:709–18.

    CrossRef  Google Scholar 

  7. Duncan CB, Riall TS. Evidence-based current surgical practice: calculous gallbladder disease. J Gastrointest Surg. 2012;16(11):2011–25.

    CrossRef  Google Scholar 

  8. Bisgaard T, Rosenberg J, Kehlet H. From acute to chronic pain after laparoscopic cholecystectomy: a prospective follow-up analysis. Scand J Gastroenterol. 2005;40:1358–64.

    CrossRef  Google Scholar 

  9. Middelfart HV, Kristensen JU, Laursen CN, Qvist N, Højgaard L, Funch-Jensen P, et al. Pain and dyspepsia after elective and acute cholecystectomy. Scand J Gastroenterol. 1998;33:10–4.

    CAS  CrossRef  Google Scholar 

  10. McMahon AJ, Ross S, Baxter JN, Russell IT, Anderson JR, Morran CG, et al. Symptomatic outcome 1 year after laparoscopic and minilaparotomy cholecystectomy: a randomized trial. Br J Surg. 1995;82:1378–82.

    CAS  CrossRef  Google Scholar 

  11. Konsten J, Gouma DJ, Von Meyenfeldt MF. Long‐term follow‐up after open cholecystectomy. Br J Surg. [Internet]. Wiley Online Library; 1993. http://onlinelibrary.wiley.com/doi/10.1002/bjs.1800800132/full.

  12. Bates T, Ebbs SR, Harrison M, A’Hern RP. Influence of cholecystectomy on symptoms. Br J Surg. 1991;78(8):964–7.

    CAS  CrossRef  Google Scholar 

  13. Vetrhus M, Berhane T, Søreide O. Pain persists in many patients five years after removal of the gallbladder: observations from two randomized controlled trials of symptomatic, noncomplicated gallstone. J Gastrointest Surg. [Internet]. Springer; 2005. http://link.springer.com/article/10.1016/j.gassur.2005.01.291.

  14. Macaron C, Qadeer MA, Vargo JJ. Recurrent abdominal pain after laparoscopic cholecystectomy. Cleve Clin J Med. 2011;78:171–8.

    CrossRef  Google Scholar 

  15. Samaraee MAA, Khan MU, Almashta DZ, Yiannakou DY. Preoperative diagnosis of choledocholithiasis: the role of MRCP. Br J Hosp Med. 2009;70:339–43.

    CrossRef  Google Scholar 

  16. Tse F, Barkun JS, Barkun AN. The elective evaluation of patients with suspected choledocholithiasis undergoing laparoscopic cholecystectomy. Gastrointest Endosc. 2004;60:437–48.

    CrossRef  Google Scholar 

  17. Romagnuolo J, Bardou M, Rahme E, Joseph L, Reinhold C, Barkun AN. Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med. 2003;139:547–57.

    CrossRef  Google Scholar 

  18. Deprez P. Approach of suspected common bile duct stones: endoscopic ultrasonography. Acta Gastroenterol Belg. 2000;63:295–8.

    CAS  PubMed  Google Scholar 

  19. Ko CW, Lee SP. Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc. 2002;56:S165–9.

    CrossRef  Google Scholar 

  20. Cetta FM. Bile infection documented as initial event in the pathogenesis of brown pigment biliary stones. Hepatology. 1986;6:482–9.

    CAS  CrossRef  Google Scholar 

  21. Kaufman HS, Magnuson TH, Lillemoe KD, Frasca P, Pitt HA. The role of bacteria in gallbladder and common duct stone formation. Ann Surg. 1989;209:584–91. discussion 591–2

    CAS  CrossRef  Google Scholar 

  22. Oddsdottir M, Hunter JG, Brunicardi FC. Gallbladder and extrahepatic biliary system. In: Schwartz’s principles of surgery. 9th ed. United States of America: The McGraw-Hill Education; 2010. p. 821–44.

    Google Scholar 

  23. Oak JH, Paik CN, Chung WC, Lee K-M, Yang JM. Risk factors for recurrence of symptomatic common bile duct stones after cholecystectomy. Gastroenterol Res Pract. 2012;2012:147821.

    CrossRef  Google Scholar 

  24. Lee D-H, Ahn YJ, Lee HW, Chung JK, Jung IM. Prevalence and characteristics of clinically significant retained common bile duct stones after laparoscopic cholecystectomy for symptomatic cholelithiasis. Ann Surg Treat Res. 2016;91(5):239–46.

    CrossRef  Google Scholar 

  25. Cox MR, Budge JP, Eslick GD. Timing and nature of presentation of unsuspected retained common bile duct stones after laparoscopic cholecystectomy: a retrospective study. Surg Endosc. 2015;29:2033–8.

    CrossRef  Google Scholar 

  26. Costamagna G, Tringali A, Shah SK, Mutignani M, Zuccalà G, Perri V. Long-term follow-up of patients after endoscopic sphincterotomy for choledocholithiasis, and risk factors for recurrence. Endoscopy. 2002;34(4):273–9.

    CAS  CrossRef  Google Scholar 

  27. Sugiyama M, Atomi Y. Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: long-term (more than 10 years) follow-up study. Am J Gastroenterol. 2002;97(11):2763–7.

    CrossRef  Google Scholar 

  28. Demetriades H, Pramateftakis MG, Kanellos I, Angelopoulos S, Mantzoros I, Betsis D. Retained gallbladder remnant after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2008;18:276–9.

    CrossRef  Google Scholar 

  29. Shaw C, O’Hanlon DM, Fenlon HM, McEntee GP. Cystic duct remnant and the ‘post-cholecystectomy syndrome’. Hepatogastroenterology. 2003;51:36–8.

    Google Scholar 

  30. Daly T, Martin CJ, Cox MR. Residual gallbladder and cystic duct stones after laparoscopic cholecystectomy Aust. N Z J Surg. 2002;72:375–7.

    CrossRef  Google Scholar 

  31. Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg. 1993;165:9–14.

    CAS  CrossRef  Google Scholar 

  32. Elshaer M, Gravante G, Thomas K, Sorge R, Al-Hamali S, Ebdewi H. Subtotal cholecystectomy for ‘difficult gallbladders’: systematic review and meta-analysis. JAMA Surg Am Med Assoc. 2015;150:159–68.

    CrossRef  Google Scholar 

  33. Duca S, Bãlã O, Al-Hajjar N, Lancu C, Puia IC, Munteanu D, et al. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. HPB. 2003;5:152–8.

    CAS  CrossRef  Google Scholar 

  34. Grbas H, Kunisek L, Zelić M, Petrosić N, Cepić I, Pirjavec A, et al. Outcome evaluation of 10,317 laparoscopic cholecystectomies: a 17-year experience at a single center. Hepatogastroenterology. 2013;60:1873–6.

    PubMed  Google Scholar 

  35. Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Staroscik RN, et al. Mortality and complications associated with laparoscopic cholecystectomy. A meta-analysis. Ann Surg. 1996;224:609–20.

    CAS  CrossRef  Google Scholar 

  36. Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg. 2001;234:549–58; discussion 558–9.

    CAS  CrossRef  Google Scholar 

  37. Nuzzo G, Giuliante F, Giovannini I, Ardito F, D’Acapito F, Vellone M, et al. Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. Arch Surg. 2005;140:986–92.

    CrossRef  Google Scholar 

  38. Turkmen S, Buyukhatipoglu H, Suner A, Apucu HG, Ulas T. Prior cholecystectomy predisposes to acute pancreatitis in codeine-prescribed patients. Int J Crit Ill Inj Sci. 2015;5(2):114–5.

    CrossRef  Google Scholar 

  39. Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG. US householder survey of functional gastrointestinal disorders. Dig Dis Sci. 1993;38(9):1569–80.

    CAS  CrossRef  Google Scholar 

  40. Cotton PB, Elta GH, Carter CR, Pasricha PJ, Corazziari ES. Rome IV. Gallbladder and sphincter of oddi disorders. Gastroenterology. 2016. https://doi.org/10.1053/j.gastro.2016.02.033.

    CrossRef  Google Scholar 

  41. Behar J, Corazziari E, Guelrud M, Hogan W, Sherman S, Toouli J. Functional gallbladder and sphincter of oddi disorders. Gastroenterology. 2006;130(5):1498–509.

    CrossRef  Google Scholar 

  42. Cotton PB, Durkalski V, Romagnuolo J, Pauls Q, Fogel E, Tarnasky P, et al. Effect of endoscopic sphincterotomy for suspected sphincter of Oddi dysfunction on pain-related disability following cholecystectomy: the EPISOD randomized clinical trial. JAMA. 2014;311:2101–9.

    CAS  CrossRef  Google Scholar 

  43. Vitton V, Delpy R, Gasmi M, Lesavre N, Abou-Berdugo E, Desjeux A, Barthet M. Is endoscopic sphincterotomy avoidable in patients with sphincter of Oddi dysfunction? Eur J Gastroenterol Hepatol. 2008;20(1):15–21.

    CrossRef  Google Scholar 

  44. Kalaitzakis E, Ambrose T, Phillips-Hughes J, Collier J, Chapman RW. Management of patients with biliary sphincter of Oddi disorder without sphincter of Oddi manometry. BMC Gastroenterol. 2010;10:124.

    CrossRef  Google Scholar 

  45. Sand J, Nordback I, Koskinen M, Matikainen M. Lindholm TS. Nifedipine for suspected type II sphincter of Oddi dyskinesia Am J Gastroenterol. 1993;88:530–5.

    CAS  PubMed  Google Scholar 

  46. Swords DS, Mone MC, Zhang C, Presson AP, Mulvihill SJ, Scaife CL. Initial misdiagnosis of proximal pancreatic adenocarcinoma is associated with delay in diagnosis and advanced stage at presentation. J Gastrointest Surg. 2015;19(10):1813–21.

    CrossRef  Google Scholar 

  47. Zang J, Yuan Y, Zhang C, Gao J. Elective laparoscopic cholecystectomy without intraoperative cholangiography: role of preoperative magnetic resonance cholangiopancreatography—a retrospective cohort study. BMC Surg. 2016;16(1):45.

    CrossRef  Google Scholar 

  48. Farahmandfar MR, Chabok M, Alade M, Bouhelal A, Patel B. Post cholecystectomy diarrhoea—a systematic review. Surg Sci 2012. http://search.proquest.com/openview/55f1f69740760442e9251b24496045d7/1?pq-origsite=gscholar.

  49. Arlow FL, Dekovich AA, Priest RJ, Beher WT. Bile acid—mediated postcholecystectomy diarrhea. Arch Intern Med Am Med Assoc. 1987;147:1327–9.

    CAS  CrossRef  Google Scholar 

  50. Schiller LR. Secretory diarrhea. Curr Gastroenterol Rep. 1999;1:389–97.

    CAS  CrossRef  Google Scholar 

  51. Hearing SD, Thomas LA, Heaton KW, Hunt L. Effect of cholecystectomy on bowel function: a prospective, controlled study. Gut. 1999;45:889–94.

    CAS  CrossRef  Google Scholar 

  52. McNamara DA, O’Donohoe MK, Horgan PG, Tanner WA, Keane FB. Symptoms of oesophageal reflux are more common following laparoscopic cholecystectomy than in a control population. Irish J Med Sci. 1998;167(1):11–3.

    CAS  CrossRef  Google Scholar 

  53. Lin OS, Kozarek RA, Arai A, Gan SI, Gluck M, Jiranek GC, Triadafilopoulos G. The association between cholecystectomy and gastroesophageal reflux symptoms: a prospective controlled study. Ann Surg. 2010;251(1):40–5.

    CrossRef  Google Scholar 

  54. Stevens S, Rivas H, Cacchione RN, O’Rourke NA, Allen JW. Jaundice due to extrabiliary gallstones. JSLS. 2003;7(3):277–9.

    PubMed  PubMed Central  Google Scholar 

  55. Schäfer M, Suter C, Klaiber C, Wehrli H, Frei E, Krähenbühl L. Spilled gallstones after laparoscopic cholecystectomy. A relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies. Surg Endosc. 1998;12:305–9.

    CrossRef  Google Scholar 

  56. Memon MA, Deeik RK, Maffi TR, Fitzgibbons RJ Jr. The outcome of unretrieved gallstones in the peritoneal cavity during laparoscopic cholecystectomy. Surg Endosc [Internet]. Springer; 1999. http://link.springer.com/article/10.1007/s004649901118.

  57. Woodfield JC, Rodgers M, Windsor JA. Peritoneal gallstones following laparoscopic cholecystectomy. Surg Endosc. 2004;18(8):1200–7.

    CAS  CrossRef  Google Scholar 

  58. Zulfikaroglu B, Ozalp N, Mahir Ozmen M, Koc M. What happens to the lost gallstone during laparoscopic cholecystectomy? Surg Endosc. 2003;17(1):15.

    Google Scholar 

  59. Petit F, Vons C, Tahrat M, Coulomb-L’Hermine A, Capron F, Franco D. Jaundice following laparoscopic cholecystectomy. An unusual complication of spilled stones. Surg Endosc. 1998;12(5):450–1.

    CAS  CrossRef  Google Scholar 

  60. Dittrich K, Weiss H. Ileus of the small intestine caused by a lost gallstone! A late complication of laparoscopic cholecystectomy. Der Chirurg Zeitschrift fur alle Gebiete der operativen Medizen. 1995;66(4):443–5.

    CAS  PubMed  Google Scholar 

  61. Chan SY, Osborne AW, Purkiss SF. Cholelithoptysis: an unusual complication following laparoscopic cholecystectomy. Dig Surg. 1998;15(6):707–8.

    CAS  CrossRef  Google Scholar 

  62. Chopra P, Killorn P, Mehran RJ. Cholelithoptysis and pleural empyema. Ann Thoracic Surg. 1999;68(1):254–5.

    CAS  CrossRef  Google Scholar 

  63. Arishi AR, Rabie ME, Khan MSH, Sumaili H, Shaabi H, Michael NT, et al. Spilled gallstones: the source of an enigma. JSLS. 2008;12:321–5.

    PubMed  PubMed Central  Google Scholar 

  64. Awwad A, Mulholland K, Clements B. Abdominal abscess due to retained gallstones 5 years after laparoscopic cholecystectomy. BMJ Case Rep [Internet]. 2010. 13 Jan 2010. http://dx.doi.org/10.1136/bcr.07.2009.2126

  65. Leslie KA, Rankin RN, Duff JH. Lost gallstones during laparoscopic cholecystectomy: are they really benign? Can J Surg. 1994;37(3):240–2.

    CAS  PubMed  Google Scholar 

  66. Iannitti DA, Varker KA, Zaydfudim V, McKee J. Subphrenic and pleural abscess due to spilled gallstones. JSLS. 2006;10:101–4.

    PubMed  PubMed Central  Google Scholar 

  67. Dobradin A, Jugmohan S, Dabul L. Gallstone-related abdominal abscess 8 years after laparoscopic cholecystectomy. JSLS. 2013;17:139–42.

    CrossRef  Google Scholar 

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Correspondence to Nicholas A. O’Rourke M.B.B.S., F.R.A.C.S. .

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O’Rourke, N.A., van Rensburg, A.J. (2018). Post Cholecystectomy Symptoms. In: Cox, M., Eslick, G., Padbury, R. (eds) The Management of Gallstone Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-63884-3_15

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