Postcholecystectomy syndrome: symptom clusters after laparoscopic cholecystectomy

Kim, Hong Beom; Han, In Woong; Heo, Jin Seok; Oh, Min Gu; Lim, Chae Woong; Choi, Yun-Sang; Lee, Seung Eun

doi:10.4174/astr.2018.95.3.135

Cited by 16 publications

(16 citation statements)

References 22 publications

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“… 18 The other RCT was to investigate the effect of Rowachol on post-Laparoscopic cholecystectomy pain, however, the authors also assess symptom clusters including diarrhoea, once again meriting including into the study. 10 The studies and data obtained are shown in table 1 .…”

Section: Resultsmentioning

confidence: 99%

“… 39 Talseth et al study found that PCD was more common in patients having cholecystectomy for biliary colic, while Manriquez et al 22 asserted that it was more common in patients having cholecystectomy for asymptomatic cholelithiasis. 22 41 On the other hand, Kim et al 10 identified no predictive factors including age, BMI, sex, American society of Anaesthetists score, preoperative Endoscopic retrograde cholangiopancreatography (ERCP), comorbidities, difficult laparoscopic cholecystectomy, open conversion or pathology. 10 Wanjura et al 42 found that several factors were predictive of worse gastrointestinal symptoms after cholecystectomy, including female gender, CBD stones or pancreatitis and gallstone pain as an indication for surgery, however, did not particularly relate this to diarrhoea.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…Postcholecystectomy syndrome (PCS) is a symptom complex that contains functional and organic disorders of the major duodenal papilla (MDP) [1,2]. The most co mmon causes of PCS, both after cholecystectomy (CE) performed by the «open» method, and after laparoscopic CE, are: stones forgotten or moved during intervention in the choledochus from the gallbladder or cystic duct [3], recurrent choledocholithiasis (mainly after preliminary endoscopic manipulations with stone extraction attempts) [4,5], MDP restenosis after endoscopic papillosphincterotomy (EPST) [6], blind pouch syndrome, long vesical stump syndrome, biliary fistula, tubular stenosis of the distal choledochus due to chronic indurative pancreatitis, reflux cholangitis due to total EPST and wide choledochoduodenoanastomosis, electrical injury of the biliary tract [7,8].…”

Section: Introductionmentioning

confidence: 99%

Improvement of the algorithm for diagnostics of postcholecystectomy syndrome taking into account functional and organic changes in the area of the large duodenal nipple

et al. 2022

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The aim. Improving the algorithm for diagnosing patients with postcholecystectomy syndrome (PCS), taking into account functional and organic changes in the major duodenal papilla (MDP). Materials and methods. 208 patients with PCS were examined. Laparoscopic cholecystectomy (CE) was performed in 172 patients in history, open CE was performed in 36 patients. 47 patients had obstructive jaundice, 84 had signs of biliary hypertension without an increase in bilirubin, 77 had no signs of biliary hypertension and an increase in bilirubin. The following instrumental research methods were used: abdominal organs ultrasound examination (AO USE), duodenoscopy, endoscopic retrograde cholangiopancreatography (ERCP), computed tomography (CT). In the main group, to study the morphofunctional changes in MDP, duodenoscopy with parietal impedancemetry, ultrasound of the hepatobiliary zone with a choleretic load were used. Results. In the main group, 34 patients underwent ultrasound of the hepatobiliary zone and Vater's nipple area with a choleretic breakfast according to Boyden according to the method of Grigoriev P.Ya. in our modification, 21 patients had an expansion of the choledochus by 2 mm. At the same time, taking meverin led to a decrease in the diameter of the choledochus, which indicated functional changes in the MDP. In 13 patients, the expansion of the choledochus, observed when taking a choleretic breakfast, persisted with the use of antispasmodics, which indicated the presence of an organic pathology of MDP. Duodenoscopy with impedancemetry was performed in 41 patients: 20 patients had 760–820 Ohm, which indicated the presence of functional changes, 12 patients had inflammatory changes in the MDP and 703–760 Ohm were detected, 9 patients with cicatricial fibrous changes had indicators impedance measurement 640–703 Ohm. The use of ultrasound with a choleretic breakfast and duodenoscopy with parietal impedancemetry in patients of the main group made it possible to identify functional and organic (inflammatory, fibrous) changes in the MDP, which made it possible to develop a therapeutic algorithm using both conservative therapy and the use of various options for transpapillary endoscopic interventions. Conclusions. Conducting an in-depth diagnosis of morpho-functional changes in MDP using parietal impedancemetry of MDP and ultrasound of the hepatobiliary zone with choleretic load allows us to identify both functional and morphological changes in MDP, which makes it possible to develop a therapeutic algorithm using drug therapy and transpapillary endoscopic techniques.

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“…It was believed that the factors influencing the recurrence of calculi in different studies vary, which may be an important reason for the various findings. Some physicians believe that the high recurrence rate of gallstones after gallstone-conserving surgery is mainly due to residual gallstones, mucosal injury and bleeding during gallstone removal 5 .…”

Section: Introductionmentioning

confidence: 99%

A Six-Year Retrospective Follow-up of 502 Patients with Laparoscopic Cholelithotomy for Gallstone Recurrence: Success or Prospect

Aliou

Zhao

Huang

et al. 2019

Preprint

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Background This research was designed to explore the risk factors for gallstone recurrence after laparoscopic cholelithotomy. Methods A total of 502 patients who were diagnosed with gallstones using ultrasonography underwent laparoscopic cholelithotomy between January 2011 and December 2017 at the Shanghai-East Affiliated Hospital of Tongji University. Results Our retrospective study revealed that the gallstone recurrence rate of patients taking tauro-ursodeoxycholic acid (TUDCA) was significantly lower (P<0.05) than that of patients not taking TUDCA. The recurrence rate of gallstones in patients with an incision at the fundus of the gallbladder was significantly lower than that of the patients with an incision on the body of the gallbladder. The risk of recurrence in patients with gallstones combined with polyps was significantly higher than that in patients without polyps; the risk of recurrence of gallstones in patients with gallbladder contraction function < 50% was significantly higher than that in patients with gallbladder contraction function ≥ 50%. Additionally, the prognosis of patients without gallbladder adhesions to the peritoneum was better than that of patients with adhesions. Conclusion During the 6-year follow-up period of this study, the recurrence rate of gallstones after laparoscopic gallbladder-preserving cholelithotomy (LGPC) was 22.91%. Factors related to gallstone recurrence were use of TUDCA, location of the incision, presence of gallstones combined with polyps, gallbladder contraction function and presence of gallbladder adhesions to the peritoneum. The main cause of gallstone recurrence needs further investigation, and laparoscopic cholelithotomy remains promising for treatment of gallstone recurrence but requires thorough follow-up.

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Postcholecystectomy syndrome: symptom clusters after laparoscopic cholecystectomy

Cited by 16 publications

References 22 publications

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

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

Improvement of the algorithm for diagnostics of postcholecystectomy syndrome taking into account functional and organic changes in the area of the large duodenal nipple

A Six-Year Retrospective Follow-up of 502 Patients with Laparoscopic Cholelithotomy for Gallstone Recurrence: Success or Prospect

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