Ann Hepatobiliary Pancreat Surg.  2018 Feb;22(1):52-57. 10.14701/ahbps.2018.22.1.52.

Clinical patterns of postcholecystectomy syndrome

• Shirah BH
• Shirah HA
• Zafar SH
• Albeladi K

• KMID: 2409080
• DOI: http://doi.org/10.14701/ahbps.2018.22.1.52

Abstract

BACKGROUNDS/AIMS
Postcholecystectomy syndrome represents a heterogeneous group of symptoms and findings in patients who have previously undergone cholecystectomy. It is rare and under-reported in Saudi Arabia. It can be attributed to many complications such as bile duct injury, biliary leak, retained common bile duct stones, recurrent bile duct stones, and bile duct strictures. In this study, we aimed to analyze the causes and evaluate the approach to postcholecystectomy syndrome in our local Saudi Arabian community because of the vast number of cases encountered in our hospital for gallbladder clinical conditions and its related complications.
METHODS
A prospective cohort database analysis of 272 patients who were diagnosed and treated for postcholecystectomy syndrome between January 2000 and December 2013 were reviewed.
RESULTS
The incidence rate of postcholecystectomy syndrome was 19.8%. The male to female ratio was 1:1.45. The mean age was 37.41±7.12 years. The most common causes were as follows: No obvious cause in 50 (18.4%) patients, Helicobacter pylori infection in 43 (15.8%), pancreatitis in 42 (15.4%), peptic ulcer disease in 41 (15.1%), recurrent common bile duct (CBD) stone in 26 (9.6%), retained CBD stone in 22 (8.1%), bile leakage in 19 (7%), stenosis of the sphincter of Oddi in 12 (4.4%), cystic duct stump syndrome in 11 (4%), and CBD Stricture in 5 (1.8%). The mortality rate was 0%.
CONCLUSIONS
Any clinical presentation of postcholecystectomy should not be underestimated and be thoroughly investigated. Multidisciplinary collaboration is crucial for the best outcome and a safe approach for all the patients.

Keyword

Postcholecystectomy syndrome; Laparoscopic cholecystectomy; Gallstones; Bile duct injury; Biliary leak; Jaundice

MeSH Terms

Bile
Bile Ducts
Cholecystectomy
Cholecystectomy, Laparoscopic
Cohort Studies
Common Bile Duct
Constriction, Pathologic
Cooperative Behavior
Cystic Duct
Female
Gallbladder
Gallstones
Helicobacter pylori
Humans
Incidence
Jaundice
Male
Mortality
Pancreatitis
Peptic Ulcer
Postcholecystectomy Syndrome*
Prospective Studies
Saudi Arabia
Sphincter of Oddi

Figure

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  Fig. 1 The causes of postcholecystectomy syndrome in the local Saudi Arabian community. CBD, common bile duct.

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  Fig. 2 The treatment modalities offered to the specific causes of postcholecystectomy syndrome in the local Saudi Arabian community. ICU, intensive care unit; ERCP, endoscopic retrograde cholangiopancreatography.

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