What is Postcholecystectomy Syndrome?

Postcholecystectomy syndrome (PCS) is the term used to describe a group of symptoms some patients experience after undergoing a cholecystectomy procedure. Cholecystectomy is commonly done to remove the gallbladder, an organ which stores bile. Bile is a green fluid produced by the liver and is important in fat digestion. Studies show that about 15% of patients in these cases suffer from postcholecystectomy syndrome. Its exact mechanism is still not fully understood, but is generally attributed to the alteration of bile flow due to the absence of the gallbladder.

First described in 1947, postcholecystectomy syndrome is the persistence of several symptoms patients experience even after the operation. These include nausea, gas or bloating, vomiting, and long-term abdominal pain. It also includes symptoms often associated with the organ's removal such as diarrhea or loose bowel movement, and gastritis, or the irritation and inflammation of the stomach's lining. Newer symptoms also related to gallbladder problems that may arise after the cholecystectomy are also considered part of postcholecystectomy syndrome.

A cholecystectomy is often performed on individuals suffering from gallstones. Gallstones usually develop when bile substances harden and obstruct the normal flow of bile. Causes include a high-fat diet, history of gallstones in the family, aging, and obesity. Removal of the gallbladder, either through an open surgical procedure or through laparoscopy, is often done to relieve the patient's symptoms. Laparoscopy, which uses a scope inserted in the abdomen through small skin incisions, is usually preferred because it is less invasive.

Several studies of postcholecystectomy syndrome among patients who underwent cholecystectomy found that more than half of the patients experienced no symptoms or less intense symptoms after the operation. Only a small number indicated that their symptoms became severe post-operatively. Other research has identified possible risk factors that can increase an individual's tendency to have postcholecystectomy syndrome. These may include undergoing emergency cholecystectomy, having gallstone symptoms for a long time, and suffering from psychiatric disorders and some intestinal diseases like irritable bowel syndrome.

Treatment of postcholecystectomy syndrome often depends on the specific cause of the problem. Physicians must thoroughly evaluate these patients by doing physical examinations, laboratory tests, imaging tests, and other special procedures in order to come up with their diagnosis. Medications are usually given for relief of gastritis, hyperacidity, and diarrhea. Some may have to undergo an endoscopic retrograde cholangiopancreatography (ERCP) in order to help in the diagnosis or provide relief. ERCP is done by inserting a thin tube in the mouth down to the esophagus and stomach until it reaches the area of the gallbladder.