Persistent symptoms after cholecystectomy: A meta-analysis of causes, diagnosis, and management strategies

Background: Cholecystectomy is a widely performed surgical procedure for gallbladder disease. While it provides symptomatic relief for most patients, a subset develops post-cholecystectomy symptoms (PCS), which can range from mild dyspepsia to severe gastrointestinal disturbances. Understanding the prevalence, aetiology, and management strategies of PCS is crucial for optimizing patient outcomes.

Objective: This meta-analysis aims to evaluate the prevalence, contributing factors, and management of PCS based on existing literature.

Methods: A systematic search was conducted in PubMed, Scopus, and the Cochrane Library for studies published between 2000 and 2024. Inclusion criteria encompassed randomized controlled trials, cohort studies, and observational studies assessing PCS prevalence, risk factors, and treatment modalities. Data extraction and quality assessment were performed independently by two reviewers, and a random-effects model was used to estimate pooled prevalence and associated risk factors.

Results: A total of 45 studies with over 15,000 patients were included in the meta-analysis. The pooled prevalence of PCS ranged from 10% to 40%. The most commonly reported symptoms were: Abdominal pain (30%), Diarrhoea (15–25%), Dyspepsia (20%), Nausea (10–15%). The primary risk factors associated with PCS included bile reflux, sphincter of Oddi dysfunction (SOD), and pre-existing functional gastrointestinal disorders such as irritable bowel syndrome (IBS). Management strategies varied based on symptom aetiology and included dietary modifications, pharmacologic therapy (bile acid sequestrants, proton pump inhibitors), and endoscopic procedures for patients with SOD.

Conclusion: PCS is a significant post-operative concern affecting a substantial proportion of patients. Early identification of risk factors, patient counselling, and tailored management strategies can improve long-term outcomes. Future research should focus on standardizing diagnostic criteria and optimizing treatment approaches.