Two year prospective follow up of bowel function after cholecystectomy in 100 patients

Matthew Zapf, BA, Woody Denham, MD, Ermilo Barrera, MD, Chih E Wang, PhD, Zeeshan Butt, PhD, JoAnn Carbray, BS, John Linn, MD, Michael Ujiki, MD. NorthShore University HealthSystem.

 Introduction: Bowel dysfunction after Laparoscopic cholecystectomy (LC) is a common issue, yet little has been described on its progression. By prospectively following patients for two years after LC with a bowel dysfunction survey and clinic visits, we aimed to characterize the incidence and symptomatic profile of post-cholecystectomy bowel issues and look for conditions that associate with poor bowel outcomes.

Methods and Procedures: Patients with acute and chronic cholecystitis, cholelithiasis, choledocholithiasis, gallstone pancreatitis, and biliary dyskinesia were offered participation in our Institutional Review Board-approved study. Patients were mailed or emailed the Surgical Outcomes Measurement System (SOMS) bowel dysfunction instrument and scheduled for follow up visits at three weeks, six months, one and two years. The instrument assessed the frequency of urgent bowel movements (BM), pain with BM, abdominal cramping/pain, loose BM, constipation, and accidental stool leakage with urination.

Results: Severe urgent BM were reported in 9.4% of patients preoperatively, 7.1% at one week, 10.7% at week three, 12.9% at six months, 12.7% at one year, and 7.5% two years after LC. One year after LC, those reporting moderate to severe urgent BM had significantly greater weight gain than unaffected patients (5.5 ± 4.3 kg v 0.50 ± 5.0 kg P<0.005). Demographics and indications were not predictors of urgent BM. The incidence of severe loose BM was 9.4% pre-operation, 17.9% at week one, 3.6% at week three, 15.9% at six months, 9.1% at one year, and 7.5% at two years. In the six months prior to LC, patients lost 1.2 ± 5.8 kg, however, compared to weight at surgery, they gained 1.2 ± 4.4 kg at six months and 2.4 ± 6.4 kg at one year. Preoperative rates of severe constipation (15.6%) and bloating (12.5%) increased at one week to 21.4% and 39.3% respectively before each decreasing to less than 7.2% by week three, and below 6% through one year.

Conclusions: Constipation and bloating largely resolve by postoperative week three, while severe urgent and loose BM persist in some patients in the long-term after LC. The incidence of urgent BM may be associated with postoperative weight gain.

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