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Synopsis of Thesis on
“Evaluation & Management of Postcholecystectomy syndrome in
patients undergoing for cholecystectomy”
Course: M.S General Surgery
By:
DR ATTAULLAH SHAR
Postgraduate trainee (M.S) General Surgery
Peoples Medical College, Nawabshah
Under supervision of
Professor Ali Akbar Ghumro
Head Department of Surgery &
Incharge Surgical unit I
Peoples Medical College, Nawabshah
Evaluation & Management of Postcholecystectomy syndrome in

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patients undergoing for cholecystectomy
Introduction:
Post cholecystectomy syndrome is derived from Latin word meaning "course
together after (the) bile bag excision1
. Post cholecystectomy syndrome was first
described in 1947 by Womack and Crider defining it as the presence of symptoms
like dyspepsia, pain in upper abdomen, and nausea after cholecystectomy2
. It
is found in 5-30% of patients with 10-15% being the most reasonable range3
.
Peterli4
found that 65% of patients had no symptoms, 28% had mild symptoms,
5% had moderate symptoms and 2% had severe symptoms after
cholecystectomy. Peterli also found that post cholecystectomy syndrome was
caused by functional disorders in 26% of patients, peptic disease in 4%, wound
pain in 2.4%, stones in 1% sub hepatic space in 0.8% and incisional hernia in 0.4%
of the cases.
Post cholecystectomy syndrome is a preliminary diagnosis and should be
renamed relevant to the disease identified by an adequate work up which
includes thorough history, clinical examination & relevant investigations3, 8, 9
.
This includes complete blood count, serum amylase, lipase, liver function tests,
Prothrombin Time, blood gas analysis, hepatitis profile, thyroid function test
profile, electrocardiogram and cardiac enzymes.
Imaging studies include chest radiograph, Barium swallow, Barium meal
follow through and Barium Enema. Ultrasound is main stay in the
diagnosis of post cholecystectomy syndrome which evaluates the liver, billiary
tract, pancreas and surrounding areas. Computerized tomography scan is
advised when pathology is suspected in the pancreas. Upper and lower
gastrointestinal endoscopy, endoscopic retrograde cholangio pancreatico-
graphy may be helpful to know the cause of disease. A percutaneous
transhepatic cholangiogram or magnetic resonance cholangiopancreatography
may be of use in patients who are not candidates for or who fail in endoseopic
retrograde cholangiopancreaticography attempt. Angiography of coronary or

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intestinal vessels may be advised when pathology is suspected in vascular
pattern of these viscera.
Treatment of patients with post cholecystectomy syndrome includes
conservative treatment and surgery 5, 10, 11
.
Initially conservative treatment is advised until a definitive diagnosis is made
and specific therapy is started. Patient with irritable bowel syndrome may be
helped with the use of bulking agents, anti spasmodic, sedatives, high dose
calcium channel blockers or nitrates. Cholestyramine is given in diarrhea.
Antacids, histamine-2 receptors blocking drugs or proton pump inhibitors can
provide relief in patients with gastroesophageal reflux disease or gastritis.
Somatostatin might provide at least some relief in symptoms. In addition,
Tiomy (Mg gluconatc and methionine) vitamin B6 and Ca lactates for six weeks
or more may help to decrease symptoms of post cholecystectomy syndrome.
Surgery is performed when definitive surgical pathology is diagnosed. It
includes Endoscopic retrograde cholangiopancreatography and Transduodenal
sphincteroplasty for narrow lower end of common bile duct. Exploratory
Laparotomy is a last resort in patients in whom definitive diagnosis is not
made. While it may not be possible to prevent post cholecystectomy syndrome,
the risk for developing it can be decreased. It includes identification of factors
in risk stratification.
We will conduct this study at People's Medical College Hospital to evaluate the
risk factors of postchloecystectomy syndrome in our population of patients. We
will also look into the management of these risk factors & analyze their data &
results.
Materials & Methods
Objective of Study: To evaluate risk factors of postchloecystectomy syndrome in

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patients who will undergo for Cholecystectomy. We will also look into the
management strategy of these patients.
Study Design: - Prospective, observational study
Setting of study: Department of Surgery, Peoples Medical College,
Nawabshah.
Duration of study: One year after approval of synopsis.
Sample size: 100 cases
Inclusion Criteria:
1. All patients of either sex above the age of 15 years who will undergo
Cholecystectomy & will have persistence of same symptoms.
Exclusion Criteria:
1. All patients of gall stone disease of less than 15 years of age.
2. All gall stone disease patients who are preoperatively diagnosed as
having concomitant upper Gastro-Intestinal pathology diagnosed
clinically or through investigations.
3. Patients who lost to follow-up.
4. Patients who did not consented for study.
5. Patients diagnosed to have biliary malignancy.
.
Data collection Procedure: These patients will be admitted in different wards of
department of surgery. Detailed history will be taken from these patients especially in
data related to age, sex, symptomatology, co morbid illness & family history of upper GI
& Hepato-pancreatobiliary diseases. Thorough examination will be performed with
special focus on variables like anemia, jaundice, & general health of the individual.
Investigations to diagnose cause of postcholecystectomy syndrome will be performed. It
includes complete blood count, blood sugar, blood urea, serum amylase, lipase, liver
function tests, Prothrombin Time, hepatitis profile, thyroid function tests,
electrocardiogram and cardiac enzymes. Imaging studies include chest
radiograph, Barium studies of Upper & lower GI tract. Ultrasound,

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Computerized tomography scan. Endoscopic studies of Upper GI &
pancreaticobiliary tract. A percutaneous transhepatic cholangiogram or
magnetic resonance cholangiopancreatography may be performed where
required. Patients will be assesed for risk factors responsible for
postcholecystectomy syndrome.
Diagnosis will be made and Patients will be briefed about the diagnosis. Patients will be
informed & written consent will be granted. They will be assured that their participation
is voluntary with no harms to them in terms of getting due treatment. They will also be
given right to withdraw from study without putting any reasons.
Data Analysis Method: Data will be collected & recorded on a proforma and
results will be compiled. Variables to be studied in study includes: Age, sex,
frequency of symptoms & signs of upper GI, pancreatic & Hepatobiliary tract,
details of relevant investigations & treatment modalities. Specific statistical
tests will be applied & P-value will be calculated using SPSS version 12. These
results will be compared with national and international literature.
References:
1. Med friendly post-cholecystectomy syndrome. Pathology of Pancreas,

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Gallbladder, Extra hepatic Billiary Tract, and Ampullary Region.2005:
1 – 7. http://www.Medfricndlv.com/postcholecvstectomvsyndrome.htnil
2. Womack NA, Cridcr RL: The Persistence of symptoms following
cholecystectomy. Arm sura 1947; 126:31-55.
3. Backus HL: The so-called Postcholecystectomy syndrome. In.
Postgraduate gastroenterology; as presented in a course given under the
sponsorship of the American college of Physicians in Philadelphia,1948,
edited by HL Backus. W. B Saunders company, Philadelphia, 1950: 561.
4. Peterli R, Mcrki L, schuppisscr JP. Post cholecystectomy
complaints one year after laparoscopic cholecystectomy. Result of
prospective study of 253 patients, Chirrug. 1998; Jan; 69 (1) :55 – 60.
5. Taube HN. Unsuccessful Cholecystectomies – “The Post –
Cholecystectomy” syndrome. Can Med Assoc J. 1964 Sept 5; 91(10); 564
– 565.
6. Lehman GA, Sherman S. Sphincter of Oddi Dysfunction (Post
cholecystectomy syndrome), In: Yamada T, editor, Textbook of
Gastroenterology, 2nd
edi, Philadelphia: Lippincott; 1995: 2251 – 2262.
7. Macaron C, Qadeer MA, Margo JJ. Recurrent abdominal pain after
Laparoscopic Cholecystectomy. Cleveland clin Jr of Med 2011; 78(3):
171 – 178.
8. Fillip M, Saftoiu A, Popescu C, Gheonea DI, Iordache S, Sandulescu L
etal. Postcholecystomy Syndrome. An algorithm approach. J
Gastroenterol Liv Dis 2009; 18(1): 67 – 71.
9. Terhaar OA, Abbas S, Thornton FJ. Imaging in patients with “Post –
Cholecystomy syndrome”. An algorithm approach. Clin Radiol 2005; 60:
78 – 84.
10. Okara N, Patel A, Goldstein M, Narahaari N, Cai Q. Ursodeoxycholic
acid treatment for patients with Postcholecystomy pain & Billiary

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microlithiasis. Gastrointestinal Endoscopy 2008; 68(1): 69 – 74.
11. Tantia O, Jain M, Bimalendu S. Post cholecystectomy syndrome & re-
intervention by Laparoscopic surgery. J Min Access Surg 2008; Jul –
Sept; 4(3): 71 – 75.