How is postcholecystectomy syndrome (PCS) prevented?

Updated: Nov 28, 2018
  • Author: Steen W Jensen, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Many articles have stated that a complete preoperative evaluation is essential to minimizing the incidence of PCS and that patients should be warned of the possibility of symptoms after cholecystectomy, which may start at any time from the immediate postoperative period to decades later.

Many studies have also been performed in an attempt to identify those at increased risk for PCS and to develop a method of risk stratification. To a large extent, the data are inconsistent from study to study; however, it is generally considered that the more secure the preoperative diagnosis, the lower the risk of PCS. Other reports find a cause for PCS in as many as 95% of patients.

Since the development of oral cholecystography (OCG) in the 1920s as a preoperative aid in the detection of stones or nonfunctioning gallbladders, a wide variety of noninvasive imaging techniques have proven useful in preoperative gallbladder assessment. Ultrasonography is the most accessible and cost-effective approach in most institutions. Other noninvasive techniques include the following:

  • Hepatobiliary scintigraphy with technetium-99m ( 99mTc)-labeled iminodiacetic acid (ie, hepatoiminodiacetic acid [HIDA] scanning), [18] with and without calculation of cholecystokinin (CCK)-stimulated ejection fraction (EF)
  • Computed tomography (CT), including helical or spiral CT
  • Magnetic resonance cholangiopancreatography (MRCP)

More invasive procedures that may prove valuable in defining the biliary anatomy include the following:

  • Percutaneous transhepatic cholangiography (PTC) and ERCP, with and without biliary and ampullary manometry and sphincterotomy
  • IOC

These procedures have helped reduce the incidence of PCS by facilitating better preoperative evaluation and diagnosis, especially in patients without stones.

As technology and understanding of the functional disorders of the GI and biliary tracts improve, the ability to make a diagnosis and to treat discovered illnesses will improve as well. PCS will be a less frequent diagnosis as patients are more efficiently screened and evaluated and as specific diagnoses are confirmed.


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