Summary
The incidence of gall bladder disease in the general population is reviewed and the percentage of cases submitting to cholecystectomy who develop symptoms postoperatively is quoted from several of the larger surgical clinics in this country. The incidence appears to run between 30 and 40 per cent of cholecystectomized patients. The post-cholecystectomy syndrome is defined as a recurrence of symptoms following removal of the gall bladder resembling or identical with those which existed prior to operation.
The anatomy, physiology and pharmacology of the extra-hepatic biliary system are discussed and the various etiologies of the post-cholecystectomy syndrome are reviewed. A rational pharmacological basis for the treatment of biliary dyskinesia is presented.
Similar content being viewed by others
References
Graham, E. A., Cole, W. H. and Copher, G. H.: Cholecystography. J.A.M.A. 84:14, Jan. 3, 1925.
Mentzer, S. H.: The Pathogenesis of Biliary Calculi. Arch. Surg. 14:14, Jan. 1927.
Carter, Greene and Taiss. Diagnosis and Management of Diseases of the Biliary Tract. Philadelphia, Lea and Feabiger, 1939.
Hansen, S.: Hospitalstidende. 1926, 69:217.
Hektoen and Riesman: American Textbook of Pathology, 1922.
Mentzer, S. H.: Surg. Gyn. and Obst. 1926, 42:782.
Aronsohn, H. G. and Andrews, E.: Experimental Cholecystitis. Surg. Gyn. and Obst. 66:748, 1930.
Wolfer, J. A.: Further Evidence that Pancreatic Juice Reflex May Be Etiologic Factor in Gall Bladder Disease. Am. Surg. 109:187, 1939. The role of Pancreatic Juice in the Production of Gall Bladder Disease. Surg. Gyn. and Obst. 53:433, 1931. Pancreatic Juice as a Factor in the Etiology of Gall Bladder Disease. Surgery 1:928, 1937.
Gatch, W. D., Battersby and Wakim: The Nature and Treatment of Cholecystitis. J.A.M.A. 132:119, Sept. 21, 1946.
Bearse, C.: The Time Factor in the Development of Combplications of Gall Stones. New Eng. J. of Med. 232:338, March 22, 1945.
Crump, C.: Incidence of Gall Stones and Gall Bladder Disease. Surg. Gyn. and Obst. 53:447, 1931.
Clute, H. M. and Kenny, F. R.: The Surgical Aspect of Gallstones. New Eng. J. of Med. 231:783, Dec. 14, 1944.
Glenn, F. and Heuer, G. J.: The Surgical Treatment of Acute Cholecystitis. Surg. Gyn. and Obst. 83:50, 1946.
Clute, H. M. and Lembright, J. F.: Immediate Surgery in Acute Cholecystitis. New Eng. J. Med. 218:72, 1938.
Bensen, K. W.: Dilation of Bile Ducts and Its Relation to Distress after Cholecystectomy. Am. J. Digest. Dis. 7:1, 1940.
Bettman, R. B. and Lichenstein, G.: End Results Following Cholecystectomy. Am. J. M. Sc. 194:788, 1937.
Carter, R. F. and Marraffino, B.: Causes and Relief of Symptoms following Cholecystectomy. N. Y. State J. Med. 40:1648, 1940.
Eliason, E. L. and North, J. P.: Morbidity following Cholestectomy. Ann. Surg. 109:580. 1939.
Meyers, S. G., Sandweiss, D. J. and Saltzstein, H. C.: End Results of the Gall Bladder Operations with Analysis of Causes of Residual Symptoms. Am. J. Digest. Dis. 5:667, 1938–9.
Hellstrom, J.: Quoted by Nygaard, K. K.: On post-cholecystectomy colic with report of a case. Acta chir, Scandimav, 81:309, 1938–39.
Doubilet, H.: Clinical and Pathologic Studies of the Biliary Tract in Relation to the End Results of Operative Treatment. Read before the Surgical Section of the New York Academy of Medicine, April, 1943.
Elman, R.: The Post-cholecystectomy Syndrome. Surg. Clin. of North America, 20:124f, Oct. 1940.
Taylor, F.: The Acute Gall Bladder. Surg. Gyn. and Obst. 63:298, Sept. 1936.
Colp, R.: The Post-cholecystectomy Syndrome and Its Treatment Bull. New York Acad. of Med. 20:203, April 1944.
Dobbie, R. B.: Factors Contributing to Failures in Gall Bladder Surgery. New York State J. Med. 45:882, April 15, 1945.
Hendrickson, W. F.: A Study of the Musculature of the Entire Extrahepatic Biliary System, including that of the Duodenal Portion of the Common Bile Duct and Its Sphincter. Bull. Johns Hopkins Hosp. 9:221, 1898.
Nuboer, J. F.: Studien uher das extrahepatische Gallenwegssystem, Frankfurter Ztschr, J. Path. 41:198, 1931.
Boyden, E. A.: The Pars Intestinalis of the Common Bile Duct as Viewed by the Older Anatomists (Versalius, Glisson, Bianchi, Vater, Haller, Santoring, etc.) Anat. Rec. 66:217, Sept. 1936; Boyden, E. A.: The Sphincter of Oddi in Man and Certain Representative Animals. Surgery 1:25, 1937; Kreilkamp, B. L. and Boyden, E. A.: Variability in the Composition of the Sphincter of Oddi. Possible Factor in Pathologic Physiology of the Biliary Tract. Anat. Rec. 76:485, 1940.
Judd, E. S. and Mann, F. C.: The Effect of Removal of the Gall Bladder, an Experimental Study. Surg. Gyn. and Obst. 24:437, 1917.
Potter, J. C. and Mann, F. C.: Pressure Changes in the Biliary Tract. Am. J. Med. Sc. 171:202, 1926.
Giordano, A. S. and Mann, F. C.: The Sphincter of the Choledochus. Arch. Path. 4:943, 1927.
Kitakoji, Yoshiharu: Studien uber die Funktionen der Gallenbase und des Oddischen Munskals in Bezug auf die Absenderung der Blassengalle. 1 Mitteilung, Ueber den Einfluss von Nervengiften auf die Funktionen der Gallblase und des Oddischen Muskals. Nogoya JM Sc. 5:24, 1930.
Ivy, A. C. and Sandblon, F.: Biliary Dyskinesia. Am. Int. Med. 8:115, 1934.
Best, R. R. and Hicken, N. F.: Biliary Dyssynergia, Physiologic Obstruction of the Common Bile Duct. Surg. Gyn. and Obst. 61:721, Dec. 1935.
Walters, W., McGowan, J. M., Butsch, W. H. and Knepper, P. A.: The Pathologic Physiology of the Common Bile Duct. J.A.M.A. 109:1591, Nov. 13, 1937.
Hill, H. A.: Functional Disorders of the Extrahepatic Biliary System: Biliary Dyssynergia. Radiology 29:261, 1937.
Bergh, G. S. and Layne, J. A.: Demonstration of independent Contractions of the Sphincter of the Common Bile Duct in Human Subjects. Am. J. Physiol. 128:690, 1940.
McGowan, J. M., Butsch, W. L. and Walters, W: Pressure in the Common Bile Duct of Man, Its Relation to Pain following Cholecystectomy. J.A.M.A. 106:2227, 1936.
Doubilet, H. and Colp, R.: Resistance of the Sphincter of Oddi in the Human. Surg. Gyn. and Obst. 64:622, 1937.
Bergh, G. S.: The Sphincter Mechanism of the Common Bile Duct in Human Subjects. Surgery 11:299, 1942.
Westphal, D.: Muskel Funktion Nerven System und Pathologie dei Gallenwege. Ztschr. f. klin. Med. 96:22, 1923.
del Valle and Donovan, R. E.: Sindrome de colico hepatico provocado por fasciola hepatica. Arch. argent. d. enferm. d. apar digest 4:697, 1928–1929.
Gray, H. K. and Sharpe, W. S.: Biliary Dyskinesia, role played by remnant of the Cystic Duct. Proc. Staff Meet. Mayo Clinic 19:164, March 22, 1944.
Whipple, A. O.: Surgical Criteria for Cholecystectomy. Am. J. Surg. 40:129, June 1926.
Timoney, F. X.: Cholecystitis, Advantages of Operative Treatment in Definite Unmistakable Diseases. Am. J. Surg. 67:57, Jan. 1945.
Saunders, R. L.: Surgical Indications in Diseases of the Common Bile Duct. Ann. Surg. 119:384, March 1944.
Counsellor, V. S. and McIndoe, H. H.: Dilation of the Common Bile Ducts. Surg. Gyn. and Obst. 43:729, 1926.
Best, R. R.: Incidence of Liver Stones Associated with Cholelithiasis and Its Significance. Surg. Gyn. and Obst. 78:425, April 1944.
McGowan, J. M., Butsch W. L. and Walter, W.: Use of Glyceryl Trinitrate (Nitroglycerine) for control of pain following cholecystectomy. Ann. Surg. 104:1013, 1936.
Best, R. R. and Micken, N. F.: Therapeutic Value of Glyceryl Trinitrate in Biliary Colic and in Post-operative Phase of Biliary Tract Disease. Am. J. Surg. 39:533, 1938.
McGowan, J. M. and Henderson, F. F.: Prevention and Management of Pain following Cholecystectomy. New England J. of Med. 222:948, 1940.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Davison, W.T. The post-cholecystectomy syndrome, incidence, etiology and treatment. Jour. D. D. 14, 290–294 (1947). https://doi.org/10.1007/BF03001343
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF03001343