Post Cholecystectomy Syndrome

Post cholecystectomy syndrome (PCS) refers to a collection of symptoms that affects some patients after gallbladder removal surgery.Its occurence ranges from 5-30% or even as high as 40%.

In general, PCS is a preliminary diagnosis and should be renamed relevant to the disease identified by an adequate workup.

PCS may be caused by alterations in bile flow due to the loss of the reservoir function of the gallbladder. Two types of problems may arise. The first problem is continuously increased bile flow into the upper GI tract, which may contribute to esophagitis and gastritis. The second consequence is related to the lower GI tract, where diarrhea and colicky lower abdominal pain may result.

Epidemiology:

About 10 to 15% of people who have their gallbladder removed develop PCS. PCS can begin immediately after the surgery to remove the gallbladder or decades later. PCS is usually a temporary diagnosis until a more specific diagnosis can be made that explains the problems.

Etiology:

• previous symptoms before cholecystectomy may go on as it used to be
• previous symptoms may change its character
• some new symptoms may occur secondary to surgery itself, like wound sore, bile flow abnormalities after storage site is lost. 
• Other causes of PCS include wound pain, disorders of the digestive system, fluid buildup underneath the liver, the formation of stones, and a bulging through of an organ (or part of an organ) through a surgical scar. In about 5% of the cases, the cause of PCS is unknown.
  

symptoms:

Symptoms of postcholecystectomy syndrome may include:

    Upset stomach, nausea, and vomiting.
    Gas, bloating, and diarrhea.
    Persistent pain in the upper right abdomen.
    Diarrhea may be eased by taking the medication cholestyramine.

 

treatment:

When the cause of PCS is determined, treatment typically proceeds as it normally would according to the diagnosis. Depending on the cause, surgery may be required for treatment. Whether or not surgery is used will depend on if the particular cause is known to respond to surgery.

In patients in which no cause of PCS has been found, authors tend to perform syphincterotomy or syphincteroplasty to enlarge the exit where bile flows out to the small intestine. 

Diet:

In some cases, the symptoms may be treated by diet. Following the post cholecystectomy diet recommended by doctors is important to help prevent post cholecystectomy syndrome symptoms.

Good post cholecystectomy foods include beets, cucumbers, okra, sweet potatoes, avocadoes, acidic foods, and foods high in Omega-3 fatty acids. Foods to be avoided after gallbladder surgery include trans fats, saturated fats, dairy, eggs, coffee and black tea, most fruit juices, alcohol, chocolate, cabbage, and radishes.

According to one study, some cases of post cholecystectomy syndrome are caused by magnesium deficiency. In the study, these patients symptoms were relieved by magnesium supplementation. Foods high in magnesium may be beneficial when incorporated into the post cholecystectomy syndrome diet. Many high-magnesium foods, unfortunately, are on the list of foods to be avoided post cholecystectomy, but some good choices include avocado, brown rice, and especially halibut and spinach .

Prof. Dr. Yusuf AKCAN Gastroenteroloji Uzm. Ozel Istanbul Onkoloji Hastanesi Tel. : 0 530 286 29 80 Tel. : 0 532 652 52 06   Cevizli Mah. Toros Cad. No : 86 PK:34846 Maltepe / Istanbul ( Gulsuyu Metro duragi karsisi)