Postcholecystectomy syndrome: pain and indigestion after gallbladder surgery
After gallbladder surgery, some people have digestion problems and upper abdominal pain. The medical term for this condition is postcholecystectomy syndrome (PCS). Gallbladder removal surgery is called cholecystectomy. By medical research, postcholecystectomy syndrome strikes 10-15 percent of people without the gallbladder. More than 700,000 cholecystectomies are performed annually in the US. It may presume the crowd of individuals, which suffer from indigestion and pain after gallbladder removal.
The postcholecystectomy syndrome may occur in two weeks or two decades following gallbladder surgery. The symptoms can be mild and just diminish of person’s quality of life. For some patients, PCS makes life miserable. Mostly, it does not depend on upon the surgical techniques, equipment, or experience of the surgeon. Just absence of gallbladder causes this problem.
The typical symptoms of the postcholecystectomy syndrome include
- Intolerance of some foods, mostly fatty foods
- Upper abdominal pain
- Constant gas, bloating, flatulence
- Nausea, vomiting
- Stubborn heartburn
- Chronic diarrhea
- Symptoms, which are very far from stomach such as depression, anxiety, low memory, skin dryness or itchiness, yellowish skin, blurred vision, bruises, tingling and numbness, often colds and more
The problem is that there is no conventional treatment of the PCS. The patients are under the care of the variety of doctors and medical practitioners with different skills, knowledge, and viewpoint on the postcholecystectomy syndrome. There are three kinds of situations.
The first one is when the symptoms happen rarely, and the entire lab and visual tests are normal. Patient has symptomatic treatment with the painkillers or gets a referral to a pain management clinic, or sends to a psychiatrist for depression and anxiety. Frequently PCS misdiagnosed with gastroesophageal reflux disease, food poison or food sensitivity, gastritis, dyspepsia, IBS, dumping syndrome, etc.
The second situation, the lab, and visual tests demonstrate increases in the pancreatic or liver enzymes, presence of the dilatation of the common bile duct. Symptoms become chronic. That is followed by numerous diagnostic tests, which are often insecure, visits to the countless doctors, hospitals, and taking all sorts of medications.
The third scenario, the individual underwent many tests that revealed severe structural changes in the bile duct, pancreas, liver, duodenum, and sphincter of Oddi. At this time, patients have numerous doctor visits, medications, ER admissions, consultations of specialists, and endoscopic surgeries.
These three situations are not separate disorders; these are the different stages of the sphincter of Oddi dysfunction, chronic biliary pancreatitis, metabolic acidosis, dysbiosis, and adhesion syndrome. Biliary means connection to bile system. The health of the bile, bile ducts, sphincter of
Oddi, and gallbladder is inextricably bound to the health of the pancreas, small, large intestines, and stomach.
Like all chronic diseases, there are the functional stage, structural stage, and advanced stage of the postcholecystectomy syndrome.
Informed consent continued
Not ever disclosed to Patients, specialist medical opinion and studies list the following expected risks, side effects, diseases, syndromes and conditions after the removal of the gallbladder and its function (Cholecystectomy). The majority of these problems are not accepted by the surgeons as a risk and are blocked from disclosure to patients during the informed consent process, or advised during post-operative follow-ups.
Note: The main reasoning behind not including Post Cholecystectomy risk in patient consent forms is because Doctors are required by law and medical ethics to ensure each patients has understand all content information of the consent form before obtaining signed consent and proceeding with treatment. The Helsinki Declaration : Informed Consent obtained , ‘After ensuring that the potential subject has understood the information’
They are but not exclusive to:
|Biliary track||Biliary injury
Clip migration / Inaccurate clip placement
Nonspecific dilatation or hypertension
Dilation without obstruction
Hypertension or nonspecific dilation
Malignancy and cholangiocarcinoma
|Colon||Adhesions; incisional hernia; irritable bowel diseaseConstipationDiarrhoea
|Duodenum||AdhesionsDuodenal diverticulaIrritable bowel disease
Peptic ulcer disease
|Gallbladder and cystic Duct remnant||InflammationLeakMirizzi’s syndrome
Neuroma (Amputation ), suture granuloma
Residual or reformed gallbladder
|Liver||Chronic idiopathic jaundiceCirrhosisCyst
Fatty liver; hepatitis; cirrhosis; idiopathic jaundice
|Nerve||Intercostal lesionsIntercostal neuralgiaNeuroma
Psychic tension or anxiety
Spinal nerve lesions
|Pancreas||Benign tumorsFunctional pancreatic sphincter disorderPancreatic cysts
|Periampullary||PapillomaSphincter of Oddi dysfunction (Functional biliary sphincter disorder); spasm; hypertrophyspasm; hypertrophySphincter of Oddi stricture
|Small bowel||AdhesionsAdhesions; incisional hernia; irritable bowel diseaseIncisional hernia
Irritable bowel disease
|Stomach||Bile gastritisPeptic ulcer disease|
|Vascular||Coronary anginaInjury to hepatic artery, portal vein (pseudoaneurysm, portal vein thrombosis)Intestinal angina
|Miscellaneous||Dropped GallstonesParasitic infestation (Ascariasis)Thermal injury
Trocar site hernia
|Other||AnxietyBacteria overgrowth in the stomachBarrett’s oesophagusBezoars
Bile Acid Malabsorption
Decrease in bile secretion
Dumping of bile Syndrome
Foreign bodies, including gallstones and surgical clips
Irritable Bowel Syndrome
Pain – right upper abdomen
Pain – shoulders and abdomen
Evidence based medical studies confirming statistically significant increased risk of cancer following cholecystectomy, required by law but never disclosed by doctors during the informed consent process listed as:
Ampulla of Vater cancer
Colorectal cancer (Colon / Bowl)
Hepatocellular carcinoma cancer
Smallintestine carcinoid cancer
“Postcholecystectomy Syndrome (PCS) describes the presence of abdominal symptoms after surgical removal of the gallbladder (cholecystectomy). Symptoms of Postcholecystectomy Syndrome may include: Upset stomach, nausea, and vomiting, gas, bloating, and diarrhoea. Persistent pain in the upper right abdomen. Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy, and can be transient, persistent or lifelong”
“Biliary Diseases Laparoscopic Cholecystectomy. Postcholecystectomy Syndrome Dr. Jacob L. Turumin (Iakov L. Tyuryumin), MD, PhD, DMSci”
“The absence of the gallbladder leads to functional biliary hypertension and increased hepatic and common bile duct . 3-5 years after cholecystectomy increases right and left hepatic ducts equity.
Functional hypertension in the common bile duct contributes to the appearance of functional and hypertension in Wirsung’s pancreatic duct with the development of the phenomena of chronic pancreatitis . At the same time period in some patients this is accompanied by the progression of chronic pancreatitis, sphincter of Oddi dysfunction and duodenogastric (Biliary / bile ) reflux.
Duodenogastric reflux of mixture of bile with pancreatic juice promotes atrophic gastritis in the antral part of stomach.
From 40% to 60% of patients after cholecystectomy dyspeptic suffering from various disorders, from 20% to 40% of pains of different localization .
Up to 70% of patients after cholecystectomy have chronic effects of “bland” cholestasis, chronic cholestatic hepatitis and chronic compensatory bile acid-dependent apoptosis of hepatocytes.
Patients undergoing cholecystectomy had an increased prevalence of metabolic risk factors for cardiovascular disease, including type 2 diabetes mellitus, high blood pressure, and high cholesterol levels.
Part of patients after cholecystectomy with increased concentration of hydrophobic hepatotoxic co-carcinogenic deoxicholic bile acid in serum and/or feces with increased risk of colon cancer”
Postcholecystectomy syndrome (PCS), S. Mohandas, L.M. Almond, Department of General Surgery, Worcestershire Royal Hospital, Worcester, UK
“The incidence of postcholecystectomy syndrome has been reported to be as high as 40% in one study, and the onset of symptoms may range from 2 days to 25 years. There may also be gender-specific risk factors for developing symptoms after cholecystectomy. In one study, the incidence of recurrent symptoms among female patients was 43%, compared to 28% of male patients.”
“cholecystectomy is associated with several physiological changes in the upper gastrointestinal tract which may account for the persistence of symptoms or the development of new symptoms after gallbladder removal. The cholecyst sphincter of Oddi reflex, cholecyst-antral reflex, and cholecyst-oesophagal reflexes are all disrupted and some local upper gastrointestinal hormonal changes also occur after cholecystectomy. Thus, there is an increased incidence of gastritis, alkaline duodene gastric reflux and gastro-oesophageal reflux after cholecystectomy, all of which may be the basis for postcholecystectomy symptoms.”
The postcholecystectomy syndrome: A review, Khalid R Murshid, Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
Instance of Post Cholecystectomy Syndrome sustainably increased when patients followed for 5-9 years vs. only two years’ follow-up
Cholecystectomy and Clinical Presentations of Gastroparesis, the NIDDK Gastroparesis Clinical Research Consortium (GpCRC)*
Patients with cholecystectomy had more comorbidities, particularly chronic fatigue syndrome, fibromyalgia, depression, and anxiety. Postcholecystectomy gastroparesis patients had increased health care utilization and had a worse quality of life.
Jacob L. Turumin, Victor A. Shanturov, Helena E. Turumina Irkutsk Institute of Surgery, Irkutsk Regional Hospital, Irkutsk 664079, Russia
The basic role of the gallbladder in a human is a protective. The gallbladder decreases the formation of the secondary hydrophobic toxic bile acids (deoxycholic and lithocholic acids) by accumulating the primary bile acids (cholic and chenodeoxycholate acids) in the gallbladder, thus reducing their concentration in gallbladder-independent enterohepatic circulation and protecting the liver, the mucosa of the stomach, the gallbladder, and the colon from their effect
- Wikipedia, Postcholecystectomy syndrome. https://en.wikipedia.org/wiki/Postcholecystectomy_syndrome
- Steen W Jensen, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF Postcholecystectomy Syndrome [medscape.com]
- S.S.JaunooS MohandasL.M.Almond. Postcholecystectomy syndrome (PCS) [ScienceDirect]
- Sureka B, Mukund A. Review of imaging in post-laparoscopy cholecystectomy complications. Indian J Radiol Imaging 2017;27:470-81 [Indian Journal of Radiology and Imaging]
- Murshid KR. The postcholecystectomy syndrome: A review. Saudi J Gastroenterol [serial online] 1996 [cited 2018 Jan 15];2:124-37. Available from: http://www.saudijgastro.com/text.asp?1996/2/3/124/34017
- Girometti, R., Brondani, G., Cereser, L., Como, G., Del Pin, M., Bazzocchi, M., & Zuiani, C. (2010). Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography. [The British Journal of Radiology, 83(988), 351–361]
- Jacob L. Turumin, Victor A. Shanturov, Helena E. Turumina. Irkutsk Institute of Surgery, Irkutsk Regional Hospital, Irkutsk 664079. The role of the gallbladder in human [ScienceDirect]
- Dr. Jacob L. Turumin, MD, PhD, DMSci Biliary Diseases Laparoscopic Cholecystectomy. Postcholecystectomy Syndrome. http://www.drturumin.com/en/index.html#sthash.Y35Uey8C.dpuf
- Martin, Walton. “RECENT CONTROVERSIAL QUESTIONS IN GALL-BLADDER SURGERY.” Annals of Surgery 79.3 (1924): 424–443. Print. [PMC]
- Donato F. Altomare*, Maria T. Rotelli, Nicola Palasciano. Diet After Cholecystectomy . Current Medicinal Chemistry Volume 24 , 201 http://www.eurekaselect.com/node/152535/article
- The NIDDK Gastroparesis Clinical Research Consortium (GpCRC). “Cholecystectomy and Clinical Presentations of Gastroparesis.” Digestive diseases and sciences 58.4 (2013): 1062–1073. [PMC]
- Yong Zhang , Hao Liu , Li Li , Min Ai , Zheng Gong, Yong He, Yunlong Dong, Shuanglan Xu, Jun Wang , Bo Jin, Jianping Liu, Zhaowei Teng Cholecystectomy can increase the risk of colorectal cancer: A meta-analysis of 10 cohort studies Published: August 3, 2017 https://doi.org/10.1371/journal.pone.0181852
- Mearin, F., De Ribot, X., Balboa, A. Duodenogastric bile reflux and gastrointestinal motility in pathogenesis of functional dyspepsia. Role of cholecystectomy. Digest Dis Sci (1995) 40: 1703. https://doi.org/10.1007/BF02212691
- Simona Manea, Georgeta & Carol, Stanciu. (2008). DUODENOGASTROESOPHAGEAL REFLUX AFTER CHOLECYSTECTOMY. Jurnalul de Chirurgie. 4 [Researchgate]
Another opinions on heath risks not accepted Doctors, Surgeons, Hospital intervention consultants and not never presented to patients during informed consent process.
The body is permanently damaged and cannot be healthy without a gallbladder and its function. You can live, but in many cases you will be miserable. Some common side effects of gallbladder removal are an upset stomach, nausea, and vomiting. Gas, bloating, and diarrhoea. Persistent pain in the upper right abdomen.
It is gross medical misconduct to send a patient home and pretend you don’t need a gallbladder, and due to the considerable numbers of affected NZ patients, Under Article 32 of the 1949 Geneva Convention IV, an ongoing crime against humanity.
Most patients suffer permanent impairments of the digestive system as a consequence of cholecystectomy, and develop various disorders as a result of poor digestion. The gall bladder is a vital organ with a crucial role in the absorption of fat and fat-soluble vitamins A, D, E and K and in essential fatty acids (omega-3 and omega-6), and poor cholesterol metabolism. In the long run, this may contribute to fatty liver. The absence of the gall bladder affects not only the process of food digestion but a wide range of other internal processes as well. In time, patients who have suffered cholecystectomy are also exposed to a high risk of developing heart disease, diabetes and disorders of the nervous system. This is due to inappropriate synthesis and assimilation of vital nutrients, vitamins and minerals.
Symptoms and Conditions
|Vitamin A deficiency signs include||Dry eyes
Drying, scaling, and follicular thickening of the skin
Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks)
|Vitamin D deficiency linked to a strikingly diverse array of common chronic diseases, including:||Alzheimer’s disease
Cold and fly
Diabetes 1 and 2
Eczema & Psoriasis
Inflammatory Bowel Disease
Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks)
Signs of aging
|Vitamin E deficiency signs include:||asthma and allergies
high oxidized LDL cholesterol levels
prostate and breast cancers
|Vitamin K deficiency can lead to:||Arterial calcification
Infectious diseases such as pneumonia
|Deficiencies in essential fatty acids||Allergies
Brittle or soft nails
Cracked skin on heals or fingertips
Dandruff or dry hair
Dry Eye Syndrome
Dry, flaky skin, alligator skin, or “chicken skin” on backs of arms
Frequent urination or excessive thirst
Lowered immunity, frequent infections
Lupus erythematosus and other autoimmune diseases
Peripheral artery disease
Poor attention span, hyperactivity, or irritability
Poor wound healing
Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks)
Tissues and organ inflammation
Vascular complications from type 2 diabetes
National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. https://doi.org/10.17226/1222. https://www.nap.edu/read/1222/chapter/14#317
Source : http://www.biotherapy-clinic.com/article/postcholecystectomy-syndrome-pain-and-indigestion-after-gallbladder-surgery