Prevalence and Predictors of Changes in Bowel Habits After Laparoscopic Cholecystectomy

Abstract

Background:The incidence of cholecystolithiasis is approximately 15% of the population. It is believed that between 30-40% of cholecystectomy patients have symptoms after surgery, being changes in bowel habits the most common among them. Aim: 1) Defining the prevalence, and 2) identifying predictors of changes in bowel habits after laparoscopic cholecystectomy. Methods: This is a retrospective cross-sectional study with an initial sample of 150 patients diagnosed with cholecystolithiasis operated between July and September 2014. Patients were submitted to a questionnaire about the presence of gastrointestinal symptoms and changes in stools consistency before and after the surgical procedure. They were divided into two groups (with or without changes in bowel habits) being combined with the following variables: high blood pressure, body mass index, hypothyroidism, adherence to postoperative dietary orientations, previous abdominal and bariatric surgery. Results: The prevalence of changes in bowel habits in the study population was 35.1%. The association between it and gastrointestinal symptoms was demonstrated to be statistically significant (‰2=7.981; p=0.005), and people who did not have gastrointestinal symptoms had 2.34 times the odds of not presenting changes in bowel habits. None of the other investigated factors had shown to be a predictor of risk for post-cholecystectomy changes in bowel habits. Conclusion: 1) There was a high prevalence of changes in bowel habits, and 2) there was association between changes in bowel habits and the presence of gastrointestinal symptoms.

Ileocecal valve syndrome and vitamin b12 deficiency after surgery: a multicentric prospective study

“…Firstly, the small sample size may prevent adequate generalization of results. In addition, the investigated items are extremely subjective and influenced by several factors that may not have been adequately considered despite an appropriate statistical analysis (e.g., the possible influence of previous, concurrent, or subsequent cholecystectomy [ 32 , 33 ]). Finally, a relatively high drop-out rate was recorded in both the compilation of questionnaires and the dosage of vitamin B12, thus potentially hindering a complete rationalization of results.…”

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

“…Fisher et al 38 concluded that it was associated with being men, younger than 50 and having a high BMI, also confirmed by Yueh et al 39 and Jasim et al 40 (though in this case the age limit was less than 40 years old) while Del Grande et al 35 associated this with prior gastrointestinal symptoms, though they did not define which ones. 35 38–40 Mertens et al clarified this further by stating that it was preoperative flatulence and heartburn which predicted postoperative symptoms including diarrhoea. Yueh et al 39 also found that not following a low-fat diet could be associated with PCD.…”

“…33 Thus, it can be seen that the mechanism behind the development of PCD is still not clearly defined despite several avenues being investigated Predictive factors for PCD Predictive factors identified for PCD varied widely across studies that assessed such factors. Fisher et al 38 concluded that it was associated with being men, younger than 50 and having a high BMI, also confirmed by Yueh et al 39 and Jasim et al 40 (though in this case the age limit was less than 40 years old) while Del Grande et al 35 associated this with prior gastrointestinal symptoms, though they did not define which ones. 35 38-40 Mertens et al clarified this further by stating that it was preoperative flatulence and heartburn which predicted postoperative symptoms including diarrhoea.…”

“…The investigators did not always define what they meant by diarrhoea in a standardised manner (such as number of episodes per day and the use of the Bristol stool chart) and some divided it into ‘mild’ and ‘severe’, again without defining what classifies patients into these divisions 23. Some papers talk about decrease in stool consistency and increase in bowel motions rather than diarrhoea 35. This may tie in with increased Deoxycholic acid (DCA) concentrations after cholecystectomy, however, it was not found to increase basal rectal motility in a study by Edwards et al , though it was found to increase the sensitivity of the rectum by reducing the volume required to produce a desire to defecate, which may be another way in which DCA can effect postoperative diarrhoea 36…”

“…23 Some papers talk about decrease in stool consistency and increase in bowel motions rather than diarrhoea. 35 This may tie in with increased Deoxycholic acid (DCA) concentrations after cholecystectomy, however, it was not found to increase basal rectal motility in a study by Edwards et al, though it was found to increase the sensitivity of the rectum by reducing the volume required to produce a desire to defecate, which may be another way in which DCA can effect postoperative diarrhoea. 36 Levels of C4, which is a marker of bile acid synthesis, tend to increase after cholecystectomy thus reflecting increased synthesis postoperatively.…”