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. 1999 Dec;45(6):889–894. doi: 10.1136/gut.45.6.889

Effect of cholecystectomy on bowel function: a prospective, controlled study

S Hearing 1, L Thomas 1, K Heaton 1, L Hunt 1
PMCID: PMC1727745  PMID: 10562588

Abstract

BACKGROUND—Published estimates of the prevalence of postcholecystectomy diarrhoea derive from retrospective or uncontrolled data. They ignore functional bowel syndromes and possible changes in diet and drug use.
AIMS—To determine prospectively whether and how often cholecystectomy leads to changes in bowel function and bowel symptoms, especially to liquid stools, over and above any non-specific effect of laparoscopic surgery.
SUBJECTS—Patients: 106 adults undergoing laparoscopic cholecystectomy (85 women, 21 men). Controls: 37 women undergoing laparoscopic sterilisation.
METHODS—Before and 2-6 months after surgery patients were administered questionnaires about bowel frequency, bowel symptoms, diet, and drugs, and kept records of five consecutive defecations with assessment of stool form or appearance on a seven point scale.
RESULTS—In cholecystectomised women, stated bowel frequency increased, on average by one movement a week, and fewer subjects felt that they became constipated. However, records showed no consistent change in bowel frequency, stool form, or defecatory symptoms. Six women reported diarrhoea after the operation but in only one was it clearly new and in her it was mild. Change in dietary fibre intake did not associate with change in bowel function but stopping constipating drugs did in a minority. In women being sterilised there was no consistent change in bowel function. In men having cholecystectomy no consistent changes were observed.
CONCLUSIONS—In women, cholecystectomy leads to the perception of less constipation and slightly more frequent defecations but short term recordings show no consistent change in bowel function. Clinical diarrhoea develops rarely and is not severe.


Keywords: cholecystectomy; bowel habit; stools; diarrhoea; constipation; irritable bowel syndrome

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Selected References

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  1. Breuer N. F., Jaekel S., Dommes P., Goebell H. Fecal bile acid excretion pattern in cholecystectomized patients. Dig Dis Sci. 1986 Sep;31(9):953–960. doi: 10.1007/BF01303216. [DOI] [PubMed] [Google Scholar]
  2. Degen L. P., Phillips S. F. How well does stool form reflect colonic transit? Gut. 1996 Jul;39(1):109–113. doi: 10.1136/gut.39.1.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dowling R. H., Veysey M. J., Pereira S. P., Hussaini S. H., Thomas L. A., Wass J. A., Murphy G. M. Role of intestinal transit in the pathogenesis of gallbladder stones. Can J Gastroenterol. 1997 Jan-Feb;11(1):57–64. doi: 10.1155/1997/532036. [DOI] [PubMed] [Google Scholar]
  4. Drossman D. A., Li Z., Andruzzi E., Temple R. D., Talley N. J., Thompson W. G., Whitehead W. E., Janssens J., Funch-Jensen P., Corazziari E. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993 Sep;38(9):1569–1580. doi: 10.1007/BF01303162. [DOI] [PubMed] [Google Scholar]
  5. Edwards C. A., Brown S., Baxter A. J., Bannister J. J., Read N. W. Effect of bile acid on anorectal function in man. Gut. 1989 Mar;30(3):383–386. doi: 10.1136/gut.30.3.383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fort J. M., Azpiroz F., Casellas F., Andreu J., Malagelada J. R. Bowel habit after cholecystectomy: physiological changes and clinical implications. Gastroenterology. 1996 Sep;111(3):617–622. doi: 10.1053/gast.1996.v111.pm8780565. [DOI] [PubMed] [Google Scholar]
  7. Heaton K. W., Braddon F. E., Mountford R. A., Hughes A. O., Emmett P. M. Symptomatic and silent gall stones in the community. Gut. 1991 Mar;32(3):316–320. doi: 10.1136/gut.32.3.316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Heaton K. W., Cripps H. A. Straining at stool and laxative taking in an English population. Dig Dis Sci. 1993 Jun;38(6):1004–1008. doi: 10.1007/BF01295713. [DOI] [PubMed] [Google Scholar]
  9. Heaton K. W., Emmett P. M., Symes C. L., Braddon F. E. An explanation for gallstones in normal-weight women: slow intestinal transit. Lancet. 1993 Jan 2;341(8836):8–10. doi: 10.1016/0140-6736(93)92479-d. [DOI] [PubMed] [Google Scholar]
  10. Heaton K. W., Ghosh S., Braddon F. E. How bad are the symptoms and bowel dysfunction of patients with the irritable bowel syndrome? A prospective, controlled study with emphasis on stool form. Gut. 1991 Jan;32(1):73–79. doi: 10.1136/gut.32.1.73. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Heaton K. W., O'Donnell L. J., Braddon F. E., Mountford R. A., Hughes A. O., Cripps P. J. Symptoms of irritable bowel syndrome in a British urban community: consulters and nonconsulters. Gastroenterology. 1992 Jun;102(6):1962–1967. doi: 10.1016/0016-5085(92)90320-x. [DOI] [PubMed] [Google Scholar]
  12. Heaton K. W., Parker D., Cripps H. Bowel function and irritable bowel symptoms after hysterectomy and cholecystectomy--a population based study. Gut. 1993 Aug;34(8):1108–1111. doi: 10.1136/gut.34.8.1108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Heaton K. W., Radvan J., Cripps H., Mountford R. A., Braddon F. E., Hughes A. O. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut. 1992 Jun;33(6):818–824. doi: 10.1136/gut.33.6.818. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Lampe J. W., Fredstrom S. B., Slavin J. L., Potter J. D. Sex differences in colonic function: a randomised trial. Gut. 1993 Apr;34(4):531–536. doi: 10.1136/gut.34.4.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Lewis S. J., Heaton K. W. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997 Sep;32(9):920–924. doi: 10.3109/00365529709011203. [DOI] [PubMed] [Google Scholar]
  16. Luman W., Adams W. H., Nixon S. N., Mcintyre I. M., Hamer-Hodges D., Wilson G., Palmer K. R. Incidence of persistent symptoms after laparoscopic cholecystectomy: a prospective study. Gut. 1996 Dec;39(6):863–866. doi: 10.1136/gut.39.6.863. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Manning A. P., Thompson W. G., Heaton K. W., Morris A. F. Towards positive diagnosis of the irritable bowel. Br Med J. 1978 Sep 2;2(6138):653–654. doi: 10.1136/bmj.2.6138.653. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Manning A. P., Wyman J. B., Heaton K. W. How trustworthy are bowel histories? Comparison of recalled and recorded information. Br Med J. 1976 Jul 24;2(6029):213–214. doi: 10.1136/bmj.2.6029.213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. O'Donnell L. J., Virjee J., Heaton K. W. Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. BMJ. 1990 Feb 17;300(6722):439–440. doi: 10.1136/bmj.300.6722.439. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Philipp R., Wood N., Heaton K. W., Hughes A. Perceptions and reactions of the public to diarrhoea. J R Soc Health. 1993 Jun;113(3):128–131. doi: 10.1177/146642409311300307. [DOI] [PubMed] [Google Scholar]
  21. Ros E., Zambon D. Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years after surgery. Gut. 1987 Nov;28(11):1500–1504. doi: 10.1136/gut.28.11.1500. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Sandler R. S., Drossman D. A. Bowel habits in young adults not seeking health care. Dig Dis Sci. 1987 Aug;32(8):841–845. doi: 10.1007/BF01296706. [DOI] [PubMed] [Google Scholar]
  23. Suhr O., Danielsson A., Nyhlin H., Truedsson H. Bile acid malabsorption demonstrated by SeHCAT in chronic diarrhoea, with special reference to the impact of cholecystectomy. Scand J Gastroenterol. 1988 Dec;23(10):1187–1194. doi: 10.3109/00365528809090189. [DOI] [PubMed] [Google Scholar]
  24. Talley N. J., Weaver A. L., Zinsmeister A. R., Melton L. J., 3rd Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol. 1992 Jul 15;136(2):165–177. doi: 10.1093/oxfordjournals.aje.a116483. [DOI] [PubMed] [Google Scholar]
  25. Talley N. J., Weaver A. L., Zinsmeister A. R., Melton L. J., 3rd Self-reported diarrhea: what does it mean? Am J Gastroenterol. 1994 Aug;89(8):1160–1164. [PubMed] [Google Scholar]
  26. Talley N. J., Zinsmeister A. R., Van Dyke C., Melton L. J., 3rd Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology. 1991 Oct;101(4):927–934. doi: 10.1016/0016-5085(91)90717-y. [DOI] [PubMed] [Google Scholar]
  27. Thompson W. G., Longstreth G. F., Drossman D. A., Heaton K. W., Irvine E. J., Müller-Lissner S. A. Functional bowel disorders and functional abdominal pain. Gut. 1999 Sep;45 (Suppl 2):II43–II47. doi: 10.1136/gut.45.2008.ii43. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. van Tilburg A. J., de Rooij F. W., van den Berg J. W., van Blankenstein M. Primary bile acid malabsorption: a pathophysiologic and clinical entity? Scand J Gastroenterol Suppl. 1992;194:66–70. doi: 10.3109/00365529209096030. [DOI] [PubMed] [Google Scholar]

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