Postcholecystectomy Syndrome (PCS)

The Postcholecystectomy Syndrome (PCS): is a heterogeneous group of diseases and symptoms presenting following gallbladder removal. Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy, and can be transient, persistent or lifelong. The chronic condition is diagnosed in approximately 10% of postcholecystectomy cases.

Post-cholecystectomy Syndrome may include: 

  • Diarrhoea as a troublesome problem range from 9 to 12% of which bile acid malabsorption (BAM) , 65% of these patients. [1]
  • Depression disorders occurring in 0.9%-3.0% of patients[2]
  • Bile (duodenogastric) reflux occurring in 20%-30% of patients[3,4,5].  Likely damage attributable to chronic bile exposure post-cholecystectomy includes:
    • cellular damage to esophagogastric junction
    • bile induced Gastroesophageal Mucosal Injury (Protective barrier that constrains the acidic reflux)
    • increase the incidence of gastric and esophageal cancer
  • Sphincter of Oddi dysfunction (SOD) is seen in 1% of patients after cholecystectomy, but in 14%-23% of patients with the post-cholecystectomy syndrome [6]
  • increased Body Mass Index (weight gain) with metabolic syndrome, gastritis, liposoluble vitamin deficiency. Cholecystectomy can have nutritional and metabolic consequences and in the long-term[7]

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.”

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.

Postcholecystectomy Syndrome in more detail

Absence of the gallbladder leads to development of functional biliary hypertension and dilatation of common bile duct and the common hepatic duct. The dilatation of right and left hepatic ducts may be formed within 3-5 years after cholecystectomy. Functional hypertension in the common bile duct leads to development of functional hypertension in Wirsung’s pancreatic duct accompanied by chronic pancreatitis symptoms.

During this period in some patients this is accompanied by chronic pancreatitis progression, dysfunction of the sphincter of Oddi and duodeno-gastral reflux. Duodeno-gastral reflux causes the development of atrophic (bile-acid-depen­dent) antral gastritis . After cholecystectomy 40% to 60% of patients suffer from dyspeptic disorders, 5% to 40% from pains of different localizations. Up to 70% of patients show symptoms of chronic “bland” intrahepatic cholestasis, chronic cholestatic hepatitis and compensatory bile-acid-dependent apoptosis of hepatocytes. In some of cholecystectomized patients with high concentration of hydrophobic hepatotoxic co-cancerogenic deoxycholic bile acid in serum and/or feces high risk of the colon cancer is found.

Not 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. The majority of these problems are not accepted by the HDC as a risk and are blocked from disclosure to patients during the informed consent process, or advised during post-operative follow-ups.

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

Source references:

  1. 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. http://dx.doi.org/10.4236/ss.2012.36065
  2. Tsai M-C, Chen C-H, Lee H-C, Lin H-C, Lee C-Z (2015) Increased Risk of Depressive Disorder following Cholecystectomy for Gallstones. PLoS ONE 10(6): e0129962. https://doi.org/10.1371/journal.pone.0129962
  3. Nudo R, Pasta V, Monti M, Vergine M, Picardi N. Correlation between post-cholecystectomy syndrome and biliary reflux gastritis. Endoscopic study. https://www.ncbi.nlm.nih.gov/pubmed/2699712
  4. Lorusso D1, Pezzolla F, Montesani C, Giorgio P, Caruso ML, Cavallini A, Guerra V, Misciagna G. Duodenogastric reflux and gastric histology after cholecystectomy with or without sphincteroplasty https://www.ncbi.nlm.nih.gov/pubmed/2253017
  5. Shah Gilani SN1, Bass GA1, Kharytaniuk N2, Downes MR3, Caffrey EF3, Tobbia I3, Walsh TN4. Gastroesophageal Mucosal Injury after Cholecystectomy: An Indication for Surveillance? https://doi.org/10.1016/j.jamcollsurg.2016.12.003
  6. Bistritz, L., & Bain, V. G. (2006). Sphincter of Oddi dysfunction: Managing the patient with chronic biliary pain. World Journal of Gastroenterology?: WJG, 12(24), 3793–3802. http://doi.org/10.3748/wjg.v12.i24.3793
  7. Donato F. Altomare, Maria T. Rotelli, Nicola Palasciano. Diet After Cholecystectomy http://www.eurekaselect.com/node/152535/article
  8. Wikipedia,  Postcholecystectomy syndrome.  https://en.wikipedia.org/wiki/Postcholecystectomy_syndrome
  9. Steen W Jensen, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF Postcholecystectomy Syndrome [medscape.com]
  10. S.S.JaunooS MohandasL.M.Almond. Postcholecystectomy syndrome (PCS) [ScienceDirect]
  11. 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]
  12. 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
  13. 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]
  14. 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]
  15. Dr. Jacob L. Turumin, MD, PhD, DMSci Biliary Diseases Laparoscopic Cholecystectomy. Postcholecystectomy Syndromehttp://www.drturumin.com/en/index.html#sthash.Y35Uey8C.dpuf
  16. Martin, Walton. “RECENT CONTROVERSIAL QUESTIONS IN GALL-BLADDER SURGERY.” Annals of Surgery 79.3 (1924): 424–443. Print. [PMC]
  17. The NIDDK Gastroparesis Clinical Research Consortium (GpCRC). “Cholecystectomy and Clinical Presentations of Gastroparesis.” Digestive diseases and sciences 58.4 (2013): 1062–1073. [PMC]
  18. 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
  19. 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
  20. Simona Manea, Georgeta & Carol, Stanciu. (2008). DUODENOGASTROESOPHAGEAL REFLUX AFTER CHOLECYSTECTOMY. Jurnalul de Chirurgie. 4 [Researchgate]

Another opinion not accepted by NZ Laparoscopic Surgeons or heath consumer watch dog Health and Disability Commissioner and as such never presented to patients when legally obtaining informed consent for gallbladder surgery (Cholecystectomy)

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 negligence to send a patient home after surgery and pretend there are no side effects and can lead a perfectly normal life without a gallbladder and its purpose. Due to the considerable numbers of affected New Zealand patients, under United Nations Universal Declaration of Human Rights, Article 5 and 25 an ongoing crime is occurring.

Article 5: No one shall be subjected to cruel, inhuman or degrading treatment

Article 25: Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, or other lack of livelihood in circumstances beyond his control.

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

Source references:

  1. National Research Council. 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Washington, DC: The National Academies Press. https://doi.org/10.17226/1222https://www.nap.edu/read/1222/chapter/14#317
  2. Mike Adams. What conventional medicine won’t dare tell you about gall bladder removal surgery. http://www.naturalnews.com/007733_gall_bladder_surgery.html
  3. Barbara Bolen, PhD. Emmy Ludwig, MD. What to Do About IBS After Gallbladder Removalhttp://ibs.about.com/od/relatedconditions/a/IBS-After-Gallbladder-Removal.htm

Alternative opinions not accepted continued

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

Source : https://www.biotherapy-clinic.com/article/postcholecystectomy-syndrome-pain-and-indigestion-after-gallbladder-surgery

“In 12 years of practice, I have rarely met any ‘cholecystectomy patient’ who didn’t have to make changes to feel better afterwards. Sooner or later their underlying nutritional deficiencies caught up to them and affected their health.”

Dr. Miranda Jorgenson, licensed Chiropractic Physician

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