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Post Cholecystectomy Diarrhoea

Many of my patients enquire while consenting for Laparoscopic cholecystectomy, " What is the impact of removing gallbladder from the body? "

My usual answer is that it does not cause any major effect on body function except that 1 in 4 patient perceive increased stool frequency which settle down in 1-2 months time while 1 in 4 patients persistent debilitating diarrhoea and require treatment.

The explanation for such change in bowel function is that loss of the gall bladder's reservoir function alters bile acid metabolism. In particular, it raises the faecal concentration of deoxycholic acid, this bile acid being an agent that sensitises the rectum and can cause an urge to defecate.

Studies suggest such change in bowel function consist of a slight increase in defecation frequency or a perceived reduction in the incidence of constipation*. Those patients who had persistent debilitating diarrhoea may have Irritable Bowel Syndrome as a contributory factor.

The management of this condition is initially ruling out colonic pathology with Colonoscopy before starting the patients on Bile sequestering agent such as Cholestyramine.

* Effect of cholecystectomy on bowel function: a prospective, controlled studyS D Hearing L A Thomas K W Heaton L HuntGut 1999; 45 889-894 Published Online First: 01 Dec 1999. doi: 10.1136/gut.45.6.889


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