Postcholecystectomy diarrhoea rate and predictive factors: a systematic review of the literature

Abstract

ObjectivesCholecystectomy is one of the most common surgical procedures performed worldwide to treat gallstone-related disease. Postcholecystectomy diarrhoea (PCD) is a well-reported phenomenon, however, the actual rate, predictive factors and mechanism of action have not been well determined. A systematic review was undertaken to determine the rate and predictive factors associated with diarrhoea in the postcholecystectomy setting.MethodsThe review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol. Databases searched included Medline, Embase, Pubmed, Cochrane and Google Scholar up to 29 September 2020. The inclusion criteria consisted of cohort studies or randomised trials which investigated the rate of PCD and predictive factors. Case reports, case series, conference abstracts and expert opinion pieces were excluded as were other systematic reviews as all the original articles from those reviews were included in this review. Papers that did not include PCD as a separate entity were excluded. Bias assessment was performed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane risk of bias tool for randomised controlled trials as appropriate. Data were extracted by two authors (AF and JAA) and an overall rate of PCD was calculated. Predictive factors were also extracted and compared between studies.Results1204 papers were obtained and 21 were found to contain relevant information about PCD, including the number of patients developing diarrhoea, method of symptom assessment and time of onset postcholecystectomy. A pooled total of 3476 patients were included across the identified studies with 462 (13.3%) patients developing PCD. Possible predictive factors varied across all studies, with characteristics such as gender, age and weight of patients postulated as being predictive of PCD, with no agreement across studies.DiscussionPCD is therefore relatively common (13.3%). This has important implications for patient consent. Patients ought to be investigated early for bile acid diarrhoea in suspected PCD. More studies are required to determine the possible predictive factors for PCD. Limitations of the study included that most studies were not powered for calculation of PCD, and assessment methods between studies varied.PROSPERO registration numberCRD42019140444.

Development of functional gastrointestinal disorder symptoms following laparoscopic cholecystectomy: a prospective cohort study

“…The prospective study design allows for systemic evaluation of the changes in major FGID symptoms after cholecystectomy using validated questionnaires and the Rome III criteria. Previous studies regarding post-cholecystectomy syndrome were retrospective or did not include a control group (40). Second, patients who underwent emergency surgery for acute cholecystitis or biliary obstruction and those who underwent open cholecystectomy were excluded from this study to avoid the effects of surgical stress.…”

Efficacy and safety of Chinese herbal medicine in treating postcholecystectomy diarrhea: A systematic review and meta-analysis

“…[ 2 , 3 ] Nevertheless, postcholecystectomy syndrome (PCS) may occur weeks or months after cholecystectomy and manifests with clinical symptoms such as diarrhea, abdominal pain, and bloating. In particular, postcholecystectomy diarrhea (PCD) is a relatively well-known clinical complication [ 4 , 5 ] characterized by a prolonged course, recurrence, and persistence, which significantly affects the quality of life of patients and even causes a portion of the population to develop disability. [ 6 ] PCD is highly prevalent and protracted.…”

“…A previous review reported an average prevalence of 13.3% (2.1%–57.2%), although with the limitation of various follow-up times. [ 4 ] The 2020 Canadian Chronic Diarrhea Guidelines highlight cholecystectomy as a risk factor for chronic diarrhea. [ 7 ] In addition, Ribas et al [ 8 ] found that >50% of patients had abnormal bowel habits after cholecystectomy, of which 23% had unrelieved symptoms after 6 months.…”

The Epidemiology of Bile Acid Diarrhea in Denmark

“…3,4 BAD can occur without known underlying pathophysiology or be secondary to other conditions such as inflammatory bowel diseases, cholecystectomy, celiac disease, intestinal resection, or damage after radiotherapy. 1,5 In Denmark, the disease is diagnosed with the gold standard ⁷⁵seleniumhomotaurocholic acid (SeHCAT) test, where the 7-day retention of orally administered SeHCAT is measured. Even though the SeHCAT test is a well-known and accepted diagnostic tool, [6][7][8] BAD was not registered as a diagnosis in WHO's International Classification of Diseases Version 10 (ICD10) before 2021.…”