surgery. In some cases, the symptoms will be identical to the presenting complaints prior to cholecystectomy. This syndrome has been shown to be due to a variety of causes, although the precise cause of symptoms sometimes remains unclear. A higher incidence of post-cholecystectomy symptoms has been reported in women and in younger patients. Also, the length of time of the preoperative symptoms correlates with the likelihood of postoperative symptoms. One study showed 27% of patients operated on after the initial attack of gallbladder disease had recurrent symptoms, whereas 50% of those with preoperative symptoms of over 5 years' duration had postoperative symptoms .
In one study of the postcholecystectomy syndrome, over half the patients had abnormalities related to the biliary tree, including chole-docholithiasis, ampullary stenosis, and pancreas divisum . The syndrome is often attributed to problems related to the cystic duct remnant. In a study of 500 postcholecystectomy patients, those with cystic duct stumps greater than 1 cm experienced a higher incidence of postoperative pain . In another study, 70% of patients with severe postoperative complaints had long cystic duct remnants . Although it has been reported that cystic duct neuromas often cause symptoms and can lead to postcholecystectomy pain, this is probably not the case. It is controversial whether a long cystic duct remnant alone can lead to recurrent symptoms. It is probable that only cystic duct remnants that contain calculi cause symptoms. Some patients without definitive pathology respond favorably to sphincterotomy. Nonbiliary disease such as peptic ulcer disease, irritable bowel syndrome, and reflux esophagitis can cause abdominal pain following cholecystectomy. A thorough history and physical examination must be performed to identify these conditions.
Some use the term "postcholecystectomy syndrome" to describe the condition in patients in whom the etiology of symptoms is uncertain. There is some physiological or pathological evidence that papillary stenosis, biliary dyskinesia, or phantom pain may be responsible for symptoms in some patients .
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