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Postcholecystectomy Syndrome

By

Christina C. Lindenmeyer

, MD, Cleveland Clinic

Last full review/revision Sep 2021| Content last modified Sep 2021
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Postcholecystectomy syndrome is occurrence of abdominal symptoms after cholecystectomy.

Postcholecystectomy syndrome occurs in 5 to 40% of patients. It refers to presumed gallbladder symptoms that continue or that develop after cholecystectomy Surgery Cholelithiasis is the presence of one or more calculi (gallstones) in the gallbladder. In developed countries, about 10% of adults and 20% of people > 65 years have gallstones. Gallstones tend... read more Surgery , or to other symptoms that result from cholecystectomy. Removal of the gallbladder, the storage organ for bile, normally has few adverse effects on biliary tract function or pressures. In about 10% of patients, biliary colic appears to result from functional or structural abnormalities of the sphincter of Oddi, resulting in altered biliary pressures or heightened sensitivity.

After cholecystectomy some patients develop diarrhea due to excessive bile acids entering the colon. Often this diarrhea resolves spontaneously but may require treatment with bile acid–binding resins.

Diagnosis of Postcholecystectomy Syndrome

  • Endoscopic retrograde cholangiopancreatography (ERCP) with biliary manometry or biliary nuclear scanning

  • Exclusion of extrabiliary pain

Patients with postcholecystectomy pain should be evaluated as indicated for extrabiliary as well as biliary causes. If the pain suggests biliary colic, alkaline phosphatase, bilirubin, ALT, amylase, and lipase should be measured, and ERCP with biliary manometry or biliary nuclear scanning should be done (see Laboratory Tests of the Liver and Gallbladder Laboratory Tests of the Liver and Gallbladder Laboratory tests are generally effective for the following: Detecting hepatic dysfunction Assessing the severity of liver injury Monitoring the course of liver diseases and the response to treatment... read more and Imaging Tests of the Liver and Gallbladder Imaging Tests of the Liver and Gallbladder Imaging is essential for accurately diagnosing biliary tract disorders and is important for detecting focal liver lesions (eg, abscess, tumor). It is limited in detecting and diagnosing diffuse... read more Imaging Tests of the Liver and Gallbladder ). Elevated liver tests suggest sphincter of Oddi dysfunction; elevated amylase and lipase suggest dysfunction of the sphincter’s pancreatic portion.

Dysfunction is best detected by biliary manometry done during ERCP Endoscopic retrograde cholangiopancreatography (ERCP) Imaging is essential for accurately diagnosing biliary tract disorders and is important for detecting focal liver lesions (eg, abscess, tumor). It is limited in detecting and diagnosing diffuse... read more Endoscopic retrograde cholangiopancreatography (ERCP) , although ERCP has a 15 to 30% risk of inducing pancreatitis. Manometry shows increased pressure in the biliary tract when pain is reproduced. A slowed hepatic hilum-duodenal transit time on a scan also suggests sphincter of Oddi dysfunction. Diagnosis of papillary stenosis is based on a clear-cut history of recurrent episodes of biliary pain and abnormal liver (or pancreatic) enzyme tests.

Treatment of Postcholecystectomy Syndrome

  • Sometimes endoscopic sphincterotomy

Endoscopic sphincterotomy can relieve recurrent pain due to sphincter of Oddi dysfunction, particularly if due to papillary stenosis. Endoscopic retrograde cholangiopancreatography (ERCP) and manometry have been used to treat postcholecystectomy pain; however, no current evidence indicates that this treatment is efficacious if patients have no objective abnormalities. These patients should be treated symptomatically.

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