Corresponding author: e-mail: contact@chirurgie.ro
Diet and Postcholecystectomy Syndrome (PCS)
Daniela Radu
*, Doina Georgescu
, M. Teodorescu
Surgical Clinic County Hospital, Timisoara, Romania
Internal Medicine Department, University of Medicine and Pharmacy “V. Babes”,
Timisoara, Eftimie Murgu Sq. 2, Romania
Received: 14 July 2012; Accepted: 20 August 2012
Journal of
Agroalimentary Processes and
Technologies
______________________________________________________________________________________
Abstract
The postcholeystectomy syndrome (PCS) include: gastric discomfort, nausea, vomiting, flatulence,
abdominal distention, diarrhea, or / and persistent abdominal pain. In the 1st Surgery Clinic, 4882
cholecystectomies were performed (1994 – 2012). In absence of etiopathogenical mechanism of PCS we
can only use a symptomatic treatment. The proper diet can be a solution, and it is advisable to limit the
food that can aggravate diarrhea, foods with a high content of fat, fried foods and sauces. Elevating the
fiber quantity helps in normalizing the intestinal transit. Small and more frequent meals ensure a better
combination of the alimentary chime with the available bile. An adequate meal should include small
amounts of weak proteins, fish or chicken ,non-fat meat, accompanied by vegetables, fruit and cereals.
In conclusions, in case of functional PCS, the treatment is symptomatic, but an adequate diet may
ameliorate or even remove the disabling symptoms.
Keywords: diet, postcholecystectomy syndrome, diarrhea, abdominal pain, fiber
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1. Introduction
The postcholeystectomy syndrome (PCS) reunites
symptoms such as: gastric discomfort, nausea,
vomiting, flatulence, abdominal distention, diarrhea,
or / and persistent abdominal pain in the region
where the operation was performed. The term
postcholecystectomy syndrome (PCS) describes the
presence of symptoms after cholecystectomy [1].
In 1947, Womack and Crider first described PCS,
defining it as the presence of symptoms after
cholecystectomy [2]. These symptoms may actually
represent either [1] the continuation of symptoms
that had been interpreted as resulting from
pathology of the gallbladder or [2] the development
of new symptoms that might normally be attributed
to the gallbladder.
PCS is 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
gastrointestinal tract, which may contribute to
esophagitis and gastritis with unpleasant
symptoms which can become severe. The second
consequence is related to the lower gastrointestinal
tract, where diarrhea and colicky lower abdominal
pain may result.
Complete preoperative evaluation is essential to
minimizing this disease and that patients should be
warned of the possibility of postoperative
symptoms, which may start at any time from the
immediate postoperative period to decades later
[3,4].
The consensus opinion holds that the more secure
the preoperative diagnosis, the lower the risk of
PCS.
Study-to-study variability is great. PCS is found in
5-30% of patients, with 10-15% being the most
reasonable range. McHardy found that 7.5% of
Daniela Radu et. al. / Journal of Agroalimentary Processes and Technologies 2012, 18(3)
220
patients with PCS required hospitalization [5]. The
international incidence of PCS is almost identical to
that in the United States. Peterli found that 65% of
patients had no symptoms, 28% had mild
symptoms, 5% had moderate symptoms, and 2%
had severe symptoms [6]. Peterli also found that
PCS was caused by functional disorders in 26% of
patients, peptic disease in 4%, wound pain in 2.4%,
stones in 1%, subhepatic fluid in 0.8%, and
incisional hernia in 0.4%. Schoenemann found that
functional disorders were the most common cause
of PCS. Russello found 30% of patients with
postcholecystectomy symptoms, 13% with PCS,
and 10% with the same preoperative symptoms.
Anand had 18% of patients with symptoms (24
mild; 7 severe). Freud found that 62% of patients
had less severe symptoms than preoperatively, 31%
had the same symptoms, and 7% had more severe
symptoms [1-5].
Consensus is limited, but a proper preoperative
workup and skilled surgery should include complete
evaluation of the extrahepatic biliary tree.
The aim of this study was the therapeutic
management of patients with PCS without known
etiology.
2. Materials and Method
In the 1
st
Surgical Clinic, University of Medicine
and Pharmacy ”Victor Babes” Timisoara, Romania,
County Hospital Timis, between February.1994 –
February 2012 when 4882 cholecystectomies were
performed.
Out of the total of 4882 cholecystectomies operated
in 1
st
Surgery Clinic during 1994-2012, 3221 were
performed laparoscopically (65,99%) while the
conversion rate was 2,90% (93 cases). The
laparoscopic approach either for diagnostic and
operative purposes offers specific advantages to the
patient compared to the classical operation (Figures
1 and 2).
The analysis of our material regards a number of
488 patients (9,99%) of total cholecystectomies who
have developed PCS at different times after
cholecystectomy.
Figure 1. Ultrasound highlighting of gallstones
Figure 2. Laparoscopic cholecistectomy
Daniela Radu et. al. / Journal of Agroalimentary Processes and Technologies 2012, 18(3)
221
3. Results and Discussion
In order to evaluate their health status and social
professional reintegration, in approximately 10% of
the cases, there have been found early or late
symptoms that could be framed in PCS. Organic
PCS, caused by biliary or extrabiliary symptoms
represented only 15 % of all the pathogenic treated
cases, the rest of 85% of functional PCS requiring
symptomatic treatment and adequate diet.
We have selected a special group of patients who
developed PCS, out of which 61 cases (12,5%)
required hospitalization due to the severity of
symptoms.
The cause of PCS was detected in 14,95% of cases,
the rest of 415 patients only possibility to treat was
the symptomatic treatment. Patients with irritable
bowel disease may be helped with the use of
bulking agents, antispasmodics, or sedatives. The
irritable sphincter may respond to high-dose
calcium channel blockers or nitrates, but evidence is
not yet convincing. Cholestyramine has been of help
for patients with diarrhea alone. Antacids, histamine
2 (H2) blockers, or proton pump inhibitors (PPIs)
can occasionally provide relief for patients with
GERD or gastritis symptoms. One study showed
that lovastatin might provide at least some relief in
up to 67% of patients.
In these cases at different time intervals the
symptoms reappear, requiring treatment.
Table 1. PCS morbidity after cholecystectomy
Total nr. of
cholecistectomy
From total
(4882)
Percent
PCS 488 9.99%
PCS severe
61
12.5%
Table 2. Treatment of PCS
Total cases with PCS From total
(488)
Percent
Cured patients 73 14.95%
Unhealed cases
415
85.
04%
In 5 – 40% cholecystectomies new symptoms have
appeared, symptoms which affect the life quality of
the patients who underwent the surgical operation.
Any post-operative sydrome rise special problems
regarding their ethiology and their surgical
treatment. In the absence of the etiopathogenical
mechanism of those symptoms, after the removal of
the gallbladder we can only use a symptomatic
treatment.
The proper diet can be a solution, and it is advisable
to limit the food that can aggravate diarrhea, foods
with a high content of fat, fried foods and sauces.
Elevating the fiber quantity helps in normalizing the
intestinal transit. Small and more frequent meals
ensure a better combination of the alimentary chime
with the available bile.
An adequate diet after cholecystectomy should
include small amounts of weak proteins, such as
lacteous products, fish or chicken, non-fat meat,
accompanied by vegetables, fruit and cereals. We
have recommended this diet for patients with
cholecystectomy. We obtained good results, none of
these patients have not required hospitalization for
symptoms framed in PCS syndrome.
4. Conclusion
Digestive sufferance or persistent abdominal pain,
even after the removal of the gallbladder can be
explained through the existence of a concomitant
disease with the vesicular lithiasis, undiagnosed pre-
operatory, or by a post-operatory adherential
syndrome. Due to that, PCS may be included in the
category of iatrogenic diseases.
In the case of functional PCS, the treatment is
symptomatic, but an adequate diet may ameliorate
or even remove the disabling symptoms.
Proper diet increase the quality of life of patients
with cholecystectomy.
References
1. Mahid, S.S.; Jafri, N.S.; Brangers, B.C.; Minor,
K.S.; Hornung, C.A.; Galandiuk, S., Meta-analysis
of cholecystectomy in symptomatic patients with
positive hepatobiliary iminodiacetic acid scan results
without gallstones, Archives of Surgery 2009,
144(2), 180-187
2. Walters, J.R.; Tasleem, A.M.; Omer, O.S.; Brydon,
W.G.; Dew, T.; le Roux, C.W., A new mechanism
for bile acid diarrhea: defective feedback inhibition
of bile acid biosynthesis, Clinical Gastroenterology
and Hepatology 2009, 7(11), 1189-1194, doi:
10.1016/j.cgh.2009.04.024
3. Cote, G.A.; Ansstas, M.; Shah, S.; Keswani, R.N.;
Alkade, S.; Jonnalagadda, S.S.; Edmundowicz, S.A.;
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Available online at http://journal-of-agroalimentary.ro
Journal of Agroalimentary Processes and
Technologies 2012, 18 (3), 219-222
Diet and Postcholecystectomy Syndrome (PCS) (PDF Download Available). Available from: https://www.researchgate.net/publication/268407543_Diet_and_Postcholecystectomy_Syndrome_PCS [accessed May 21 2018].
