title: Bowel habit after cholecystectomy: physiological changes and clinical implications.
abstract: OBJECTIVE
  Scarce data suggest that cholecystectomy may alter bowel habit. The aim of this study was to determine whether cholecystectomy modifies gut transit.
  
  
  METHODS
  Five experimental groups were studied: 29 patients with uncomplicated gallstones before and 1 month after elective cholecystectomy, 22 patients 4 years after elective cholecystectomy, 14 patients with postcholecystectomy diarrhea, 5 patients with acute infectious diarrhea (disease controls), and 13 patients before and 1 month after other elective surgery (surgical controls). All participants underwent measurement of colonic transit by a modified radiopaque pellet method and orocecal transit by the standard lactulose breath H2 test.
  
  
  RESULTS
  One month postoperatively, cholecystectomy had substantially accelerated total colonic transit (51 +/- 5 hours before vs. 38 +/- 5 hours after; P < 0.05) and delayed slightly orocecal transit (80 +/- 4 minutes before vs. 103 +/- 8 minutes after; P = 0.05). Similar colonic and orocecal transit times were measured 4 years after cholecystectomy (40 +/- 4 hours and 105 +/- 8 minutes, respectively). Colonic transit times in patients with the postcholecystectomy diarrhea syndrome were accelerated as much as in patients with infectious diarrhea, who served as controls (19 +/- 3 hours and 15 +/- 4 hours, respectively). Surgery per se had no effect on gut transit.
  
  
  CONCLUSIONS
  Cholecystectomy shortens gut transit by accelerating colonic passage. These sequelae develop early and persist at least 4 years after cholecystectomy. The postcholecystectomy diarrhea syndrome probably represents a magnification of the above colonic sequelae.
authors.affiliation: Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Fort
authors.forename: F
authors.initials: F
authors.lastname: Azpiroz
authors.forename: F
authors.initials: F
authors.lastname: Casellas
authors.forename: J
authors.initials: J
authors.lastname: Andreu
authors.forename: J R
authors.initials: JR
authors.lastname: Malagelada
mesh_terms: D000328:Adult; D002763:Cholecystectomy / Q000009:adverse effects*; D002769:Cholelithiasis / Q000601:surgery; D003106:Colon / Q000503:physiopathology; D003672:Defecation; D003967:Diarrhea / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005772:Gastrointestinal Transit; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D013577:Syndrome