Post-cholecystectomy Syndrome: Causes, Symptoms and Treatment

Post-cholecystectomy syndrome or PCS is an accumulation of heterogeneous symptoms among the patients who have opted for cholecystectomy. It is a rare condition and generally, 40% or 5 patients are affected by it. However, with proper diagnosis and treatment, a person can get back normal biliary tract function and speedy recovery.

What is Post-cholecystectomy Syndrome?

Abdominal pain and gallbladder disease are interlinked because over 500,000 US citizens follow the advice of undergoing cholecystectomy every year. Majority of the patients does not face any complicated effects; however, a minor portion of patient notices the symptoms or signs of Post-cholecystectomy syndrome. In most of the cases, the symptoms start showing up months or weeks later.

Laparoscopic cholecystectomy gained popularity in 1986 for treating the gallstone disorder. There have been various reasons for becoming popular,

    • Improved restoration
    • Fewer chances of morbidity
    • Reduced hospitalization expense
    • Financial savings

Moreover, this medical procedure ensured successful operation providing complete relief to 90% of the sufferers. Now the disease, PCES, is comprised of recurrent symptoms that are similarly found before undergoing cholecystectomy. Jaundice dyspepsia and upper abdominal pain are observable during the physical condition.

Causes of Post-cholecystectomy Syndrome

The physical condition goes unnoticed for a long time and it is associated with an exorability disease like peptic ulceration, chronic pancreatitis, reflux oesophagitis and irritable bowel syndrome. Following are the causes of PCES that you should know,

  • Retained calculi
  • Biliary stricture
  • Chronic biloma or abscess
  • Dropped calculi
  • Long cystic duct remnant
  • Bile leakage
  • Dyskinesia or stenosis of the sphincter of oddi

There are primarily two problems that take place in PCS. The patient can suffer high bile flow without interruption into GI or gastrointestinal tract. This issue is susceptible to cause gastritis and oesophagitis.

The other problem is associated with lower gastrointestinal tract where colicky lower abdominal pain and diarrhea occur. Nevertheless, with proper treatment following effective communication with the medical professional can provide you with full recovery.

Symptoms of Post-cholecystectomy Disease

 The main cause of PCS is considered to be bile among the patients who have suffered from mild gastro-duodenal symptoms along with diarrhea. Elimination of reservoir operation of your gallbladder changes bile flow. However, why the change in bile flow is directly connected to the syndrome is still under research.

Due to the lack of technical equipment, it was not possible for the medical professionals to identify anatomic malfunctions due to PCS. The doctors had to follow microscopic solution for choosing exploratory surgery. With the better evaluation of biliary tract disease, the medical field can utilize improved imaging studies for checking the signs.

Post gallbladder surgery may display a set of symptoms that include,

  • Indigestion
  • Tummy pain
  • Diarrhea
  • High fever over 100.4F
  • Jaundice or yellow eyes or skin

PCS is the cause of bile leakage into several regions including the stomach. But in a few rare cases, the gallstones remain in the bile ducts that create further complications.

Risk Related to Post-cholecystectomy Disorder

During the last decade of the 20th century, 5,00,000-6,00,000 cholecystectomy surgical procedures were performed per year in the United States. As said earlier, only 10% of patients had the chance of developing Post-cholecystectomy syndrome. Therefore, 50,000 cases were filed under the health condition every year.

  • One of the studies refers to the fact that only 7.5% of the cases needed hospital admission and the other parts of the world faced the same situation as the United States.
  • Another study indicates that 28% of patients suffered mild symptoms, 2% faced severe symptoms, 5% observed moderate symptoms and 65% of them did not have any symptoms at all.
  • Half of the patients suffering from the preoperative disease have a natural reason for developing Post-cholecystectomy syndrome. However, only 23% of patients with no psychiatric condition have a natural cause.

There is a lack of understanding on specifying the risk factors of PCS; however, a large portion of the medical professionals agree that skilled surgery and preoperative exercise would limit the complications. However, the following are the risk factors related to PCS,

  • After performing choledochotomy, 23% of the patients have the chance to suffer from PCS. On the contrary, if the method is not performed, there are only 19% of chances.
  • If the patient notices the symptoms less one year before the surgery, there are 10-25% of possibilities of developing the disease. If preoperative symptom period is over 10 years, there are 34% of chances of going through the disorder.
  • 10-25% of patients may develop Post-cholecystectomy syndrome when the surgical procedure is to be performed for removing stones only. If there is the presence of stone, 29% of patients may have PCS.

Apart from all of these factors, the immediate need for surgery increases the risk rapidly.

Age is a Factor in PCS

Many of the research studies indicate that Post-cholecystectomy syndrome symptoms are similar to the preoperative condition. Stone spill, bile spill and previous surgery did not leave any adverse effects on the incidence of Post-cholecystectomy syndrome. However, among all of the risk factors, sex and age change the scenario.

When the 15% of male inpatients develop the syndrome, 28% of female patients are at high risk. Following are the age groups that are at risk of developing Post-cholecystectomy syndrome,

  • 20-29 years old – 43%
  • 30-39 years old – 27%
  • 40-49 years old – 21%
  • 50-59 years – 26%
  • 60-69 years old – 31%

People over 70 years old do not generally develop the symptoms of Post-cholecystectomy syndrome.

 Treatment of Post-cholecystectomy

There is no need of worrying about PCS because it is only a temporary disease and the medical professionals can treat it over certain procedures. When the diagnosis is complete, the doctor decides the treatment as per the condition. Here, you should know that the treatment procedure includes the surgical or medical option.

Pharmacologic Therapy

Patients suffering from IBS or irritable bowel syndrome can take get relief from the administration of sedatives, antispasmodics or bulking agents. The problematic sphincter responds to a high dose of calcium channel nitrates or blockers. However, the result is convincing in every case.

Cholestyramine helps people developing diarrhea. Proton pump inhibitors, histamine 2 blockers and antacids can relieve the patients having gastritis symptoms or GERD or gastroesophageal reflux disease.  In this case, lovastatin has been able to provide relief from the symptoms among 67% of patients.

Gastric bile salt concentration is helpful for the patients dealing with the dyspeptic syndrome.

Surgical Procedure to Follow

Similar to the medicinal therapy, the surgical therapy follows the diagnosis. If there is an identifiable case of post-cholecystectomy syndrome responding well to operative administration, a surgical method is widely helpful. For the syndrome, ERCP or endoscopic retrograde cholangiopancreatography is chosen as it is therapeutic and diagnostic. Exploratory surgery is the last option taken for the patients who do not have a diagnosis and this condition is stubborn to the medicinal therapy.

The method which includes resection of nerve and scar tissue surrounding cystic duct dump is considered controversial. Other medical professionals indicated sphincter dilation, cystic duct remnant, resection of neuroma, common bile duct exploration and biliary bypass. However, the amputation of neuroma is a much-talked topic in the medical world.

Patients with a history of excessive alcohol use face difficulties in utilizing the poly-cholecystectomy syndrome. In this type of medical cases, exploratory surgery is postponed and the medical professionals strictly suggest refraining from drug abuse.

Easing Post-cholecystectomy Syndrome Symptoms

The gallbladder surgery is the solution to gallstones and it has become a very common condition with the aging people. Gallbladder does not carry out significant roles but it helps in digesting fatty foods. Moreover, it can concentrate, secrete and store bile produced by the liver.

When there is no gallbladder, your gallbladder fails to digest fatty food and there are certain complications which lead to Post-cholecystectomy syndrome. Here is what you should think of eating after going through the surgery.

Low-Fat Foods

High-fat foods or fried foods should be avoided at any cost. It is better to follow a low-fat diet and the fat calories should be no more than 30% of daily intake. When you consume 1,800 calories per day, you should not eat more than 60 gm of fat. It is wise to check the food label always for understanding whether the food does not have more than 3 gm of fat per serving.

Follow High-Fiber Foods


The high-fiber foods are essential because they are known as gas-producing foods. It is important to include small portions of these foods in the diet but you should take it slow. If you introduce them quickly, you can suffer a lot.

Go through the following list to know what to eat for staying safe during Post-cholecystectomy syndrome,

  • Cabbage
  • Cereal
  • Cauliflower
  • Broccoli
  • Brussels sprouts
  • Legumes
  • Nuts
  • Seeds
  • Whole-grain bread

Generally, the Post-cholecystectomy syndrome surgery requires you to have clear liquid sustenance like gelatin or broth. When you are preparing yourself to include the foods, you should do that slowly.

You can also focus on consuming steamed veggies as they have the strength to improve bind bile acid. When you are chowing down on cabbage, mustard greens, green bell peppers or collard greens, you make sure that the large intestine remains safe.

Inclusion of Lean Protein

As the whole-grain or veggies may become too mundane to eat, you can add lean protein for making your daily diet more palatable. Moreover, the gallbladder does not digest protein and there is no chance of undergoing unwanted digestive signs available in high protein. But you should keep in mind to stay away from the fatty cut of meat.

Following is the list of lean protein which is good for your health,

  • Halibut, flounder and cod
  • Lean cut of beef
  • White meat turkey or chicken
  • Lean cut of pork

Forget about High-fat Foods

Eating high-fat food post gallbladder surgery can only upset your health and it will lead to diarrhea, bloating and pain. The gastrointestinal discomfort is a problematic issue and even a symptom of Post-cholecystectomy syndrome. It is better to remove these foods from your diet completely,

  • Pizza
  • Chocolate
  • High-fat meat like ground beef, sausage and bologna
  • Meat gravy
  • Palm oil and coconut oil
  • Creamy sauce and soup
  • Cheese, whole milk and ice cream
  • Pizza
  • Potato chips and French fries

Maintain a Journal

After having gone through a surgery, it is a good option to keep a food journal. In this way, it becomes easy to keep track of what you are consuming and the impact of the food on your health. Generally, people start following a regular diet but there may be signs of Post-cholecystectomy syndrome.

If you notice these signs, you should have a talk with your doctor,

  • Diarrhea lasting more than three days after the surgery
  • Inability to pass gas for more than 36 hours after the surgery
  • Lack of bowel movements for a few days
  • Jaundice
  • Vomiting or severe nausea
  • Worsening, severe or persistent abdominal pain

Follow-up care is necessary after undergoing the surgery and it is found that the sufferer has faced initial ERCP during bile leak treatment. During, more abnormalities are observed and the problems include CBD sludge without stones, CBD stones and persistent bile leak.

After returning from the hospital, you may get up and move around the house and even take the stairs also. However, physical exercise can only deteriorate your health condition and you should start exercising deep breathing four to five times a day. Activities like lawn mowing, moving the furniture and lifting heavy objects can be strenuous for your health.

In the end, it can be discerned that poly-cholecystectomy syndrome can be treated when you let your medical professional know about the problems. You should follow your doctor’s advice and abide by them for achieving a speedy recovery.

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