The functional post-cholecystectomy and irritable bowel syndromes: how close these entities?
No not as a routine, but yes if there is suspicion of IBS, we do evaluate as per the Rome III criteria
Drossman DA, Whitehead WE, Camilleri M. Irritable
bowel syndrome. A technical review for practice guideline
development. Gastroenterology 1997;112:2120–37 and Thompson WG, et al / Functional bowel disorders and functional abdominal pain // Gut 1999;45(Suppl II):II43–II47 estimate the IBS rate as 15-20% of Western population, and Corazziari E, et al / Gallstones, cholecystectomy and irritable bowel syndrome (IBS) MICOL population-based study // Dig Liver Dis. 2008 Dec;40(12):944-50 wrote:
'Irritable bowel syndrome subjects have an increased risk of cholecystectomy that is not due to an increased risk of gallstones, but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications.'
Moreover, some authors believe that 'There is a lack of objective criteria for cholecystectomy in symptomatic cholecystolithiasis. The national guidelines in Denmark advocate cholecystectomy only in patients with socially disabling pain attacks. ... Asymptomatic gallstones should not be operated upon.'
How is the matter considered in your place?
The latter sentence cited from Eriksen JR, Boel T, Schulze S, Kristiansen VB. / Hvad sker der hos personer med galdeblaeresten, hvis de ikke far foretaget kolecystektomi? Opfolgning af 222 konsekutive patienter med initialt ubehandlet galdestenssygdom // Ugeskr Laeger. 2007 Oct 22;169(43):3649-52
At our place we offer cholecystectomy only to patients who are symptomatic for gallstones, though we do not consider the socially disabling pain attacks as the criteria...we offer cholecystectomy even to those patients who complain of pain in RHC which lasts for more than 6 hours...
So, if the attack duration due to a stone entrapment into nech of the gallbladder lasts more than 30-40 min (and met the Tokyo criteria for the AC. Usually, it is all the same), some think it IS the acute cholecystitis!
And what about elective surgery?
Yes if it is a characteristic biliary colic, we do offer elective surgery without concentrating much on the Rome criteria for IBS
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