Postcholecystectomy Syndrome

Abstract

re-formed gall bladder in his description of the condition. The term re­ formed gall bladder should be applied to those cases in which incomplete or subtotal cholecystectomy had been performed. Since the symptomatology may be caused by other pathophysiologic changes, a more descriptive term for this condition would be postcholecystectomy cystic duct syndrome. This syndrome may be caused by a number of conditions: disease originating remotely from the biliary tract; residual hepatitis, cholangitis and/or pancreatic disease; biliary dyskinesia or dyssynergia; stones in the hepatic and/or common bile ducts; and cystic duct pathology produced by inflammation, adhesions and stones. Disappointing surgical results with recurrence of symptoms are observed in from 20 to 40 per cent of postcholecystectomy cases. The vast majority of these occur, following surgery of the non calculous gall bladder. In a study of cholecy­ stectomized patients, Meyers and his colleagues 24 found that 83 per cent of calculous cholecystitis cases were benefited, while only 41 per cent were symptom­ atically relieved in the noncalculous group. Causes Biliary dyskinesia. Deserving of comment is the question of functional disorders of the sphincter of Oddi. The frequency of disturbance of the sphincter of Oddi mechanism as a contributing factor in the production of symptoms has been a controversial issue. Some authorities believe that biliary dyskinesia accounts for the majority of cases of recurrence of symptoms, while others believe that it plays but a small part. Womack and Crider40 have questioned whether the part played by the sphincter of Oddi and the mechanism of reciprocal innervation is a dominant one. Lehmann 18 has shown that dyskinesia of the sphincter of Oddi does not playa significant role in causing pain. According to Upham,39 the role of spasm of the sphincter of Oddi is no longer felt to be the leading cause of postcholecystectomy syndrome. Mallet-Guy and Rose 20 found in manometric studies that spasm occurred in 20 per cent of cholecystectomized