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
- Constipation
- 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:
|
Anatomy |
Etiology |
| Biliary track | Biliary injury Cholangitis Choledochoduodenal fistula Choledocholithiasis Clip migration / Inaccurate clip placement Dyskinesia Nonspecific dilatation or hypertension Obstruction Strictures Stump cholelithiasis Adhesions Cyst Dilation without obstruction Fistula Hypertension or nonspecific dilation Malignancy and cholangiocarcinoma Trauma |
| Bone | Arthritis |
| Colon | Adhesions; incisional hernia; irritable bowel diseaseConstipationDiarrhoea Incisional hernia |
| Duodenum | AdhesionsDuodenal diverticulaIrritable bowel disease Peptic ulcer disease Perforation |
| Esophagus | AchalasiaAerophagiaDiaphragmatic hernia Esophagitis Hiatal hernia |
| Gallbladder and cystic Duct remnant | InflammationLeakMirizzi’s syndrome Mucocele Neuroma (Amputation ), suture granuloma Residual or reformed gallbladder Stump cholelithiasis |
| Liver | Chronic idiopathic jaundiceCirrhosisCyst Dubin-Johnson syndrome Fatty liver; hepatitis; cirrhosis; idiopathic jaundice Gilbert disease Hepatitis Hydrohepatosis Liver abscess Sclerosing cholangitis |
| Nerve | Intercostal lesionsIntercostal neuralgiaNeuroma Neurosis Psychic tension or anxiety Spinal nerve lesions Sympathetic imbalance |
| Pancreas | Benign tumorsFunctional pancreatic sphincter disorderPancreatic cysts Pancreatic stone Pancreatitis Stone Tumors |
| Periampullary | PapillomaSphincter of Oddi dysfunction (Functional biliary sphincter disorder); spasm; hypertrophyspasm; hypertrophySphincter of Oddi stricture Stricture |
| Small bowel | AdhesionsAdhesions; incisional hernia; irritable bowel diseaseIncisional hernia Irritable bowel disease |
| Stomach | Bile gastritisPeptic ulcer disease |
| Subcutaneous tissue | AbscessHematoma |
| Vascular | Coronary anginaInjury to hepatic artery, portal vein (pseudoaneurysm, portal vein thrombosis)Intestinal angina Mesenteric ischemia |
| Miscellaneous | Dropped GallstonesParasitic infestation (Ascariasis)Thermal injury Trocar site hernia |
| Other | AnxietyBacteria overgrowth in the stomachBarrett’s oesophagusBezoars Bile Acid Malabsorption Bile Reflux Bloating Celiac Disease Cramps Decrease in bile secretion Depression Diabetes Dumping of bile Syndrome Foreign bodies, including gallstones and surgical clips Gas Gastroparesis GERD Reflux Heartburn Irritable Bowel Syndrome Nausea Pain – right upper abdomen Pain – shoulders and abdomen Thyrotoxicosis Weight gain Weight loss |
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:
Anatomy |
Etiology |
| Other Biliary tract Liver Colon Esophagus Stomach Liver Liver Pancreas Periampullary Other |
Adrenal cancer Ampulla of Vater cancer Cholangiocarcinoma cancer Colorectal cancer (Colon / Bowl) Esophageal cancer Gastric cancer Hepatocellular carcinoma cancer Liver cancers Pancreatic cancer Periampullary cancer Smallintestine carcinoid cancer |
Wikipedia
“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
Source references:
- 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.
Vitamin deficiency |
Symptoms and Conditions |
| Vitamin A deficiency signs include | Dry eyes Drying, scaling, and follicular thickening of the skin Night blindness Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks) Respiratory infections |
| Vitamin D deficiency linked to a strikingly diverse array of common chronic diseases, including: | Alzheimer’s disease Asthma Autism Cancer Cavities Cold and fly Crohn’s disease Cystic fibrosis Diabetes 1 and 2 Dementia Depression Eczema & Psoriasis Hearing loss Hypertension Heart disease Infertility Inflammatory Bowel Disease Insomnia Macular degeneration Migraines Multiple Sclerosis Muscle pain Obesity Osteoporosis Periodontal disease Preeclampsia Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks) Rheumatoid arthritis Septicemia Seizures Schizophrenia Signs of aging Tuberculosis |
| Vitamin E deficiency signs include: | asthma and allergies brain damage cancer cognitive decline high oxidized LDL cholesterol levels hot flashes menstrual pain poor circulation prostate and breast cancers |
| Vitamin K deficiency can lead to: | Arterial calcification Cardiovascular disease Dementia Infectious diseases such as pneumonia Leukemia Liver cancer Lung cancer Osteoporosis Prostate cancer Tooth decay Varicose veins |
| Deficiencies in essential fatty acids | Allergies Alzheimer’s disease Asthma Bone weakness Brittle or soft nails Cancer Cracked skin on heals or fingertips Dandruff or dry hair Dry eyes Dry Eye Syndrome Dry, flaky skin, alligator skin, or “chicken skin” on backs of arms Fatigue Frequent urination or excessive thirst Gallstones Heart disease Lowered immunity, frequent infections Lupus erythematosus and other autoimmune diseases Multiple sclerosis Parkinson’s disease Peripheral artery disease Poor attention span, hyperactivity, or irritability Poor mood Poor wound healing Postpartum depression Premature birth Problems learning Red or white acne-like bumps (on your cheeks, arms, thighs, and buttocks) Rheumatoid arthritis Schizophrenia Tissues and organ inflammation Ulcerative colitis 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
http://www.naturalnews.com/007733_gall_bladder_surgery.html
http://ibs.about.com/od/relatedconditions/a/IBS-After-Gallbladder-Removal.htm
Source : http://www.biotherapy-clinic.com/article/postcholecystectomy-syndrome-pain-and-indigestion-after-gallbladder-surgery
