Post Cholecystectomy Diarrhoea—A Systematic Review


Introduction: Post-cholecystectomy diarrhoea (PCD) is probably the most distressing postoperative non-pain symptom. Its nature is not fully understood. The aim of this systematic review was to assess the prevalence, aetiology, predisposing factors and management of PCD from the past study reports. Methods: We conducted a wide ranged review of published literature on PubMed, Web of Knowledge, and the Cochrane library without any time limitation. Results: Twenty five studies were included. The prevalence of PCD was 9.1% (302/3306) with no significant difference between genders. The prevalence of bile acid malabsorption (BAM), the most important suggested aetiological factor, was seen in 65.5% (36/55) patients with PCD. There were no obvious predisposing factors. We found 92% (23/25) of patients with PCD responded to cholestyramine therapy. The cure rate for cholecystectomy on preoperative cholegenic diarrhoea was 54.5% (121/222). The prevalence of post-cholecystectomy new onset constipation was 7.9% (78/987). Conclusion: The aetiology of PCD is unknown and appears to be multifactorial. The BAM prevalence was only 65.5%, however 92% of PCD patients responded to cholestyramine therapy suggesting that cholestyramine therapy could also have curative effect on other unknown aetiological factors related to bile metabolism. The complexity of the aetiology of PCD is more projected by considering the curative effect of cholecystectomy on preoperative cholegenic diarrhoea, and the occurrence of post-cholecystectomy new onset constipation. However, the relationship between cholecystectomy and PCD is an undeniable fact.

Share and Cite:

M. Farahmandfar, M. Chabok, M. Alade, A. Bouhelal and B. Patel, "Post Cholecystectomy Diarrhoea—A Systematic Review," Surgical Science, Vol. 3 No. 6, 2012, pp. 332-338. doi: 10.4236/ss.2012.36065.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] G. P. H. Gui, C. V. N. Cheruvu, N. West, K. Sivaniah and A. G. Fiennes, “Is Cholecystectomy Effective Treatment for symptomatic gallstones? Clinical outcome after Long-Term Follow-Up,” Annals of Royal of College of Surgeons of England, Vol. 80, No. 1, 1998, pp. 25-32.
[2] M. Fisher, D. C. Spilias and L. K. Tong, “Diarrhoea after Laparoscopic Cholecystectomy: Incidence and Main Determinants,” ANZ Journal of Surgery, Vol. 78, No. 6, 2008, pp. 482-486. doi:10.1111/j.1445-2197.2008.04539.x
[3] F. L. Arlow, A. A. Dekovich, R. J. Priest and W. T. Beher, “Bile Acid Mediated Postcholecystectomy Diarrhea,” Archives of Internal Medicine, Vol. 147, No. 7, 1987, pp. 1327-1329. doi:10.1001/archinte.1987.00370070139021
[4] G. H. Sauter, A. C. Moussavian, G. Meyer, H. O. Steitz, K. G. Parhofer and D. Jüngst. “Bowel Habits and Bile Acid Malabsorption in the Months after Cholecystectomy,” American Journal of Gastroenterology, Vol. 97, No. 7, 2002, pp. 1732-1735. doi:10.1111/j.1572-0241.2002.05779.x
[5] G. Sciarretta, A. Furno, M. Mazzoni and P. Malaguti, “Post Cholecystectomy Diarrhea: Evidence of Bile Acid Malabsorption Assessed by SeHCAT Test,” American Journal of Gastroenterology, Vol. 87, No. 12, 1992, pp. 1852-1854.
[6] J. M. Fort, F. Azpiroz, F. Casellas, J. Andreu and J. R. Malagelada, “Bowel Habit after Cholecystectomy: Physiological Changes and Clinical Implications,” Gastroenterology, Vol. 111, No. 3, 1996, pp. 617-622. doi:10.1053/gast.1996.v111.pm8780565
[7] C. A. Moussavian, K.G. Parhofer and D. Juengst, “Effect of Cholecystectomy on Bile Acid Metabolism and Serum Lipoprotein Profiles,” Gastroenterology, Vol. 118, No. 4, 2000, pp. A884-A884. doi:10.1016/S0016-5085(00)85675-9
[8] G. H. Sauter and C. A. Moussavian, “Occurrence of Bile Acid Malabsorption after Cholecystectomy,” Hepathology, Vol. 30, No. 4, 1999, pp. 685A-685A.
[9] B. Niranjan, S. Chumber and A. K. Kriplani, “Symptomatic Outcome after Laparoscopic Cholecystectomy,” Tropical gastroenterology, Vol. 21, No. 3, 2000, pp. 144-148.
[10] W. Luman, W. H. Adams, S. N. Nixon, I. M. Mcintyre, D. Hamer-Hodges, G. Wilson and K. R. Palmer, “Incidence of Persistent Symptoms after Laparoscopic Cholecystectomy: A Prospective Study,” Gut, Vol. 39, No. 6, 1996, pp. 863-866. doi:10.1136/gut.39.6.863
[11] S. D. Hearing, L. A. Thomas, K.W. Heaton and L. Hunt, “Effect of Cholecystectomy on Bowel Function: A Prospective, Controlled Study,” Gut, Vol. 45, No. 6, 1999, pp. 889-894. doi:10.1136/gut.45.6.889
[12] M. Lublin, D. L. Crawford, J. R. Hiatt and E. H. Phillips, “Symptoms before and after Laparoscopic Cholecystectomy for Gallstones,” American Surgeon, Vol. 70, No. 10, 2004, pp. 863-866.
[13] S. Skoog, J. Simonson, A. Arora, N. Diehl, W.S. Harmsen, G. R. Locke, G. Longstreth, Y. Romero, J. Thistle, A. Zinsmeister, and A. E. Bharucha, “Post-Cholecystectomy Diarrhea: A Prospective Study of Incidence,” Gastroenterology, Vol. 126, No. 4, 2004, pp. A370-A370.
[14] M. Victorzon, M. Lundin, C. Haglund, P. J. Roberts and I. Kellokumpu, “Short and Long Term Outcome after Laparoscopic Cholecystectomy,” Annales Chirurgiae et Gynaecologiae, Vol. 88, No. 4, 1999, pp. 259-263.
[15] E. Ros and D. Zambon, “Post Cholecystectomy Symptoms. A Prospective Study of Gall Stone Patients before and two Years after Surgery,” Gut, Vol. 28, No. 11, 1987, pp. 1500-1504. doi:10.1136/gut.28.11.1500
[16] W. C. Watson and C. Marsh, “Post Cholecystectomy Bowel Function,” Gastroenterology, Vol. 96, No. 5, 1989, p. A538.
[17] K. W. Heaton, D. Parker and H. Cripps, “Bowel Function and Irritable Bowel Symptoms after Hysterectomy and Cholecystectomy a Population Based Study,” Gut, Vol. 34, No. 8, 1993, pp. 1108-1111. doi:10.1136/gut.34.8.1108
[18] R. G. Wilson and I. M. Macintyre, “Symptomatic Outcome after Laparoscopic Cholecystectomy,” British Journal of Surgery, Vol. 80, No. 4, 1993, pp. 439-441. doi:10.1002/bjs.1800800410
[19] C. S. Huang, F. C. Tai, M. Y. Shi, D. F. Chen and N. Y. Wang, “Complications of Laparoscopic Cholecystectomy: An Analysis of 200 Cases,” Journal of the Formosan Medical Association, Vol. 91, No. 8, 1992, pp. 785-792.
[20] D. Parker and K. W. Heaton, “Diarrhoea after Cholecystectomy: An Understimated Problem?” Gut, Vol. 32, No. 10, 1991, p. A1254.
[21] M. A. Mcnally, G. R. Locke, A. R. Zinsmeister, C. D. Schleck, J. Peterson and N. J. Talley, “Biliary Events and an Increased Risk of New Onset Irritable Bowel Syndrome: A Population-Based Cohort Study,” Alimentary Pharmacology and therapeutics, Vol. 28, No. 3, 2008, pp. 334-343. doi:10.1111/j.1365-2036.2008.03715.x
[22] G. C. Vander Velpen, S. M. Shimi and A. Cuschieri, “Outcome after Cholecystectomy for Symptomatic Gall Stone Disease and Effect of Surgical Access Laparoscopic v Open Approach,” Gut, Vol. 34, No. 10, 1993, pp. 1448-1451. doi:10.1136/gut.34.10.1448
[23] L. S. Schultz, M. Kamel, J. N. Graber and D. F. Hickok, “Four-Years Outcome Data for 400 Laparoscopic Cholecystectomy Patients: Recognition of Persistant Symptoms,” International Surgery, Vol. 79, No. 3, 1994, pp. 205-208.
[24] H. Fromm, C. A. Sherman, A. K. Tunuguntla and S. Ceryak, “Post Cholecystectomy (pcc) Diarrhea: Does Bile Acid Malabsorption Play a Role,” Gastroenterology, Vol. 86, No. 5, 1984, pp. 1082-1082.
[25] G.A. Ford, J. D. Preece, I. H. Davies and S. P. Wilkinson, “Use of the SeHCAT Test in the Investigation of Diarrhea,” Postgraduate Medical Journal, Vol. 68, No. 798, 1992, pp. 272-276. doi:10.1136/pgmj.68.798.272
[26] S. Eusufzai, M. Axelson, B. Angelin and K. Einarsson, “Serum 7 Alpha-hydroxy-4-cholesten-3-one Concentrations in the Evaluation of Bile Acid Malabsorption in Patients with Diarrhoea: Correlation to SeHCAT Test,” Gut, Vol. 34, No. 5, 1993, pp. 698-701. doi:10.1136/gut.34.5.698
[27] O. Suhr, A. Danielsson, H. Nyhlin and H. Truedsson, “Bile Acid Malabsorption Demonstrated by SeHCAT Test in Chronic Diarrhea, with Special Reference to the Impact of Cholecystectomy,” Scandinavian Journal of Gastroenterology, Vol. 23, No. 10, 1988, pp. 1187-1194. doi:10.3109/00365528809090189
[28] S. Eusufzai, “Bile Acid Malabsorption in Patients with Chronic Diarrhea,” Scandinavian Journal of Gastroenterology, Vol. 28, No. 10, 1993, pp. 865-868. doi:10.3109/00365529309103126
[29] J. Sand, S. Pakkala and I. Nordback. “Twenty to Thirty Year Follow-Up after Cholecystectomy,” Hepato-gastroenterology, Vol.?43, No. 9, 1996, pp. 534-537.
[30] A. P. Manning, J. B. Wyman and K. W. Heaton, “How Trustworthy Are Bowel Histories? Comparison of Recalled and ?Recorded Information,” British Medical Journal, Vol. 2, No. 6029, 1976, pp. 213-214. doi:10.1136/bmj.2.6029.213
[31] K. W. Heaton, J. Radvan, H. Cripps, R. A. Mountford, F. E. Braddon and A. O. Hughes, “Defecation Frequency and Timing, ?and Stool Form in the General Population: A Prospective Study,” Gut, Vol. 33, No. 6, 1992, pp. 818-824. doi:10.1136/gut.33.6.818

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.