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Background: Bariatric surgery predisposes patients to development of cholelithiasis, and therefore the need of a subsequent cholecystectomy; however, the incidence of cholecystectomy after bariatric surgery is debated., Objective: The purpose of our study is to assess the incidence of cholecystectomy after 3 of the most common bariatric procedures., Setting: University Hospital, involving a large database in New York State., Methods: The Statewide Planning and Research Cooperative System administrative longitudinal database was used to identify all patients undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) between 2004 and 2010. Through the use of a unique identifier patients were followed to evaluate for the need of a subsequent cholecystectomy over at least 5 years. Cox proportional hazard regression analysis was used to identify risk factors for subsequent cholecystectomy., Results: During this time period, there were 15,301 LAGB procedures, 19,996 RYGB, and 1650 SG. There were 989 (6.5%) patients who underwent cholecystectomy after LAGB, 1931 (9.7%) patients after RYGB, and 167 (10.1%) after SG. Approximately one quarter of follow-up cholecystectomies were performed at the same institutions. LAGB and RYGB were less likely to have a subsequent cholecystectomy compared with SG (hazard ratio .5, 95% confidence interval .4-.6 for LAGB; and hazard ratio .7, 95% confidence interval .6-.9 for RYGB). Risk factors for a subsequent cholecystectomy included age, sex, race, and some co-morbidities and complications (P<.05) based on a multivariable Cox proportional hazard model., Conclusion: The rate of cholecystectomy after LAGB, RYGB, and SG was 6.5%, 9.7% and 10.1%, respectively. Patients should be counseled preoperatively about this risk and biliary prophylaxis should be contemplated., (Published by Elsevier Inc.)

Cholecystectomy has long been regarded as a safe procedure with no deleterious influence on the body. However, recent studies provide clues that link cholecystectomy to a high risk for metabolic syndrome (MetS). In the present review, we describe the epidemiologic evidence that links cholecystectomy to MetS. Various components of MetS are investigated, including visceral obesity, dyslipidemia, elevated blood pressure, impaired fasting glucose, and insulin resistance. The possible mechanisms that associate cholecystectomy with MetS are discussed on the basis of experimental studies.

Results of cholecystectomy performance were analyzed in 99 patients with a biliary calculous disease, the course of which have become complicated by cholecystitis occurrence, in 49 of them professional diseases of respiratory organs, including silicosis, antracosis, were registered. Estimating results of laparoscopic and open cholecystectomy, we have established, that carboperitoneum in laparoscopic cholecystectomy impacts negatively the course of early postoperative period, what manifests with hemodynamic and respiratory disorders. The level of fibronectin and endotelin--1 in the blood plasm directly depends on the respiratory disorders severity and may be applied as a test for respiratory dysfunction. The method of cholecystectomy in patients, suffering professional diseases of respiratory organs, must be selected, depending on severity of functional disorders of respiratory organs.

Unlabelled: The aim of the present study was a comprehensive study of the features autonomic nervous system in cholelithiasis before and after cholecystectomy., Materials and Methods: 88 patients aged 40 to 60 years. 55 patients with cholelithiasis before and after laparoscopic cholecystectomy (CE). Control group consisted of 33 patients of similar age and gender. To investigate the function of the autonomic nervous system were evaluated themes complaint history, physical examination data, and used less Tod mathematical analysis of cardiac rhythm by Baevsky RM using the author's computer-related programs "Korveg" with the definition of heart rate variability and table--Solovevoj Wayne., Results and Conclusions: The study of autonomic provision in rest and during exercise were increased sympathetic activity, exceeding those in the control group. Studies indicate a tendency to sympathicotonia patients with gall stones before and after cholecystectomy, which is enhanced adaptive compensatory mechanisms to maintain homeostasis in the body. Identify logical connections between clinical and autonomic indicators will predict flow pattern cholelithiasis before and after cholecystectomy, as well as pick individual therapy for each patient taking into account the autonomic features that can be widely used in practical medicine--not.

Treatment results of 1048 elderly patients, operated on the cholelithiasis, were analyzed. The group of minilaparotomic access cholecystectomy numbered 488 (46,6%) patients; the second group consisted of 560 (53,4%) patients, who had the traditional operation. All patients were operated on in a single hospital during 1998-2008 yy. The cholecystectomy from minilaparotomic access proved to be less traumatic and preferable for elderly patients. The rate of postoperative morbidity was 5,7%, mortality - 0,2%. The procedure, though, is subjected to the experienced surgeons.

Objective: To compare the effect of laparoscopic cholecystectomy (LC) and open cholecystectomy (OC) on liver function and immune function., Methods: Forty-two patients with normal liver function underwent LC (n=21) or OC (n=21) according to the patients' preference. One day before and 7 days after the operations, the liver functions (ALT, AST, TBIL, ALB) and immune functions (CD3, CD4, CD8, NK cell percentage, IgA, IgM, IgG and C3, C4) of the patients were measured., Results: No statistical differences were found in the liver functions or immune functions between the two groups after the operation., Conclusion: LC and OC show no significant difference in the effects on the liver function and immune function.

Objective: To determine the proportion and timing for suspecting the diagnosis of gall bladder carcinoma in patients undergoing cholecystectomy for cholelithiasis., Methods: A retrospective study conducted at the Aga Khan University Hospital, Karachi over a period of six years, included medical records of patients, with cholecystectomy for cholelithiasis and a histopathological diagnosis of gall bladder carcinoma. An extensive review was done with special reference to the features of suspected or unsuspected gall bladder carcinoma. Timing of suspicion was categorized on the basis of clinical features, investigations, operative and histopathological findings., Results: Out of 1396 cholecystectomies performed during the period of study, sixteen patients (1.15%) were diagnosed as gall bladder carcinoma. Only three patients had pre-operative ultrasonographic features to raise suspicion for gall bladder malignancy whereas eight patients were suspected to have a malignant lesion, on the operative findings. Five patients were missed and the diagnosis was established after histopathological examination., Conclusion: The ultrasonography can miss a significant number of malignant lesions of the gall bladder and every cholecystectomy specimen should be examined histologically.

Objective: Gallbladder removal is associated with an increased incidence of gastroesophageal reflux, but the mechanism is unclear. Cholecystokinin (CCK) release, which causes gallbladder contraction, is inhibited by bile in the duodenum. This study investigates the effect of cholecystectomy on meal-stimulated CCK secretion., Methods: Three groups of patients were studied. Group 1 (n = 15) were normal controls. Group 2 (n = 27) were patients with symptomatic gallstones. Group 3 (n = 25) were patients who had undergone cholecystectomy. Meal-stimulated CCK levels were measured by radioimmunoassay at defined time points for 60 min after a standard corn oil-based meal., Results: Fasting CCK levels were similar in all three groups. In postcholecystectomy patients, meal-stimulated plasma CCK levels were significantly elevated compared with controls: median (range) integrated CCK values for 60 min were 116 (28-209) in controls, 123 (20-501) in gallstone patients, and 176 (63-502) after cholecystectomy., Conclusions: This study suggests that cholecystectomy causes an exaggerated meal-stimulated CCK response. Because CCK is known to relax the lower esophageal sphincter. these findings may help explain the increased incidence of gastroesophageal reflux seen after cholecystectomy.

Background: A group of patients referred to general surgeons for the treatment of gall bladder stones was studied to evaluate the role of a numerical symptom scoring system (biliary symptom score (BSS)) as a tool to improve the assessment of patients and reduce the incidence of post-cholecystectomy symptoms., Methods: Fifty-seven patients with gallstones and abdominal symptoms referred to general surgeons were studied. All patients were interviewed by a surgeon in training independently from the treating surgeon and given a subjective and objective assessment of their symptoms (using the BSS); they were then categorized into biliary, non-biliary and possible biliary groups. The results of the interviews remained unknown to the treating surgeon throughout the period of study. The symptom status of all patients was reevaluated 6-12 months later; the patients' outcome was compared with their initial objective score and the subjective assessment by the independent assessor and with the treating surgeon's initial assessment., Results: Fifty-one patients were able to be analysed. Subjective independent assessment and BSS were closely correlated (phi = 0.89). Use of the BSS improved the accuracy of the independent assessor from 53% (subjective assessment) to 69%, but this was at the cost of recommending cholecystectomy in 30% of the patients with non-biliary symptoms. The accuracy of experienced consultant general surgeons was 98% with a single case of post-cholecystectomy syndrome (2%)., Conclusion: Numerical BSS improves diagnostic accuracy for a surgeon in training by reducing the number of patients classified with possible biliary symptoms, but it remains significantly less accurate than the subjective clinical assessment of an experienced consultant general surgeon.

Objective: To investigate the recovery of gastrointestinal motility after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC)., Methods: Motilin (MOT), gastrin (GAS), electrogastrogram (EGG), the peristaltic sound recovery timing (PSRT) and the anorectum exhaust timing (AET) were determined in 30 patients having LC and 18 patients having OC., Results: MOT, GAS, EGG frequency and EGG amplitude on the first, second and third day after operation in LC group were not significantly different in comparison with preoperative data (P > 0.05), but significant difference on the first and second postoperative day compared with preoperative data and data of the the LC group (P < 0.05). The PSRT and AET in the LC group were much shorter in comparison with the OC group (P < 0.05)., Conclusions: The recovery of gastrointestinal motility after LC is earlier than OC, which justifies early feeding for patients after LC.

To investigate the effects of cholecystectomy on gastric motor function, 13 patients with symptomatic gallstones were studied before and 8-12 months after surgery. Twelve healthy subjects entered the study as control group. The cutaneous electrogastrography and ultrasound examination of gastric emptying were simultaneously performed at pre- and post-prandial states. The dominant gastric frequency and its coefficient of variation were not affected by surgery. After cholecystectomy, an increase in normal 3 cpm wave percentage and a decrease in power ratio were found (P < 0.05 and P < 0.01, respectively). Gastric emptying recorded after cholecystectomy was faster than before surgery (306.9 +/- 15.9 min vs 336.9 +/- 11.8 min, respectively; P < 0.05). Such changes were associated with the relief of symptoms, and the comparison between patients and controls showed a normalization of the gastric electrical activity and gastric emptying after surgery. In conclusion, in symptomatic patients, gallstones are associated with motor dysfunctions, and cholecystectomy seems to induce a normalization of gastrointestinal motility.

The object of this study was to define the pattern of gastrointestinal myoelectrical activity before and after cholecystectomy. After surgery, on the first postoperative day, the mean and maximal activities of the gastrointestinal tracts decreased significantly, but there was no significant change in the pattern and the duration of the nonreactive period. A dyskinetic effect and/or weakness of electrical activity was observed in all patients before operation, and the same pattern persisted after operation for one month. This suggests the future onset of the so-called postcholecystectomy syndrome, which may result from the fundamental pathological effect of gallstones.

We have performed a clinical study involving patients with symptomatic gallstones and indications for surgery, to analyze the biliary and pancreatic response to the quality of dietary fat (degree of unsaturation). As part of the investigative method, we have designed a clinical protocol adapted to the needs of the study, in this respect, we have used gastrointestinal intubation to obtain independent samples of gastric and duodenal juices, by means of a long nasoduodenal tube or a modified Dreimlich tube, placed manually in the intraoperative period, during the cholecystectomy. The characteristics of the tube are such that its manipulation is difficult, which led to situations postoperatively and during sampling, which may alter or invalidate the obtained drainage material. In the present study we define the protocol and the phases of the investigation, and we reflect on the usefulness of the Dreimlich tube as a method, analyzing its advantages and disadvantages.

In this prospective, clinical study, four groups, each consisting of 12 patients were established to determine how gastric emptying is influenced in cholelithiasis with accompanied flatulent dyspepsia and the relationship of symptoms and gastric emptying after cholecystectomy: group 1--healthy people; group 2--patients with dyspeptic cholelithiasis; group 3--patients with no dyspepsia after cholecystectomy; group 4--patients with dyspepsia after cholecystectomy. Groups are compared according to solid phase gastric emptying scintigraphies performed with Tc 99m sulphur colloid bound with scrambled eggs. Gastric emptying delayed in groups 2 (P < 0.001) and 4 (P < 0.005) postprandially and did not differ in the group 3 (P > 0.005). These results demonstrate that dyspepsia, in cholelithiasis and persisting after cholecystectomy, has a close relation with delay in gastric emptying.

Dyspepsia is a common complaint in patients presenting with gallstone disease. Since the stomach appears to be its site of origin, the present study was undertaken to assess gastric emptying in patients with gallstone disease and to find out its correlation with dyspeptic symptoms before and after cholecystectomy. Gastric emptying (t1/2) was prospectively assessed in 43 patients with symptomatic gallstones (29 with and 14 without dyspepsia). These data were compared with that of 20 healthy volunteers (control group). Delayed gastric emptying (> 112 min: mean + 2 s.d. of the control group) was observed in 18 patients (42%; P < 0.002), 10 of whom presented with dyspepsia and eight without (NS). Re-evaluation in 18 of the 29 patients with dyspepsia, 3 months after cholecystectomy, revealed complete disappearance of symptoms in three, improvement in 11 and no change in four patients. After 6 months, two patients had reverted back to their pre-operative dyspeptic status; resulting in three patients completely cured, nine partially cured and six without any change in their dyspeptic status at this time. Gastric emptying was delayed in nine of the 18 patients before cholecystectomy. After cholecystectomy, normal emptying was observed in all but one patient (P < 0.005). Dyspeptic symptoms, however, completely disappeared in one patient, improved in five and remained unchanged in three. In the remaining nine patients, gastric emptying was normal both before and after cholecystectomy. Gallstone disease is associated with delayed gastric emptying but this delay was not the cause of dyspepsia in these patients. Cholecystectomy normalizes gastric emptying, a finding that has not been reported previously.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this work was to study the influence of cholelithiasis and cholecystectomy on duodenogastric biliary reflux. Total bile acid concentration (TBAC) in fasting gastric juice was measured in 23 consecutive patients with cholelithiasis and functioning gallbladder before and at least 3 months after cholecystectomy (group 1) and in 14 healthy volunteers (group II). In group two, TBAC was 8.5 +/- 2.8 uMol/l (mean +/- sem), the preoperative value in group I was 32.8 +/- 8.9 uMol/l and the postoperative value 69.9 +/- 14 uMol/l (p < 0.002 compared with group II and < 0.035 compared with preoperative values). These results suggest that cholelithiasis, even with a functioning gallbladder is associated with a significant increase in bile reflux to the stomach, with raises further after cholecystectomy.

Inpatient extracorporeal shockwave lithotripsy for treatment of gallbladder stones has not previously been compared with open cholecystectomy in terms of cost-effectiveness. In a randomised controlled trial, 163 patients, stratified by gallstone bulk (over 4 cm3 or not), were randomised to lithotripsy or cholecystectomy (38 large-bulk and 27 small-bulk cholecystectomy; 37 large-bulk and 61 small-bulk lithotripsy) and followed up for 1 year. Both treatments gave significant health gains in terms of a reduction in episodes of biliary pain, improved perceived health status, and symptom relief, but few differences between treatments were found. There was some evidence that biliary-pain episodes were less severe after cholecystectomy. Cholecystectomy patients also had greater improvements in mean health gain for three related symptoms: vomiting, feeling sick, and fatty-food upset. However, there were no differences between groups in perceived health status. Among lithotripsy patients, health gain was not related to stone clearance. Lithotripsy was more expensive than cholecystectomy, principally because of the costs of the inpatient stay and adjuvant bile-salt therapy. Conventional lithotripsy appears at least as cost-effective as cholecystectomy for patients with small-bulk stones but less cost-effective for those with large-bulk stones. To some extent treatment choice can be guided by patient preference.

Duodenogastric reflux (DRG) was quantified with continuous 24 hour monitoring of gastric pH in 30 patients, 12 of whom underwent operation for repair of an inguinal or femoral hernia used as a control group. The remaining 18 patients with noncomplicated gallstone disease underwent a simple cholecystectomy. Eight weeks after the operation, the tests were repeated. We found that patients with cholelithiasis were accompanied with DGR or alkaline shift more often than the patients in the control group and cholecystectomy decreased the percentage of time that gastric pH was less than two and increased the time at four and six. Although cholecystectomy itself does cause DGR, most patients with DGR may be asymptomatic.

The impact of our evolving health care system on a commonly performed surgical procedure, cholecystectomy, was assessed in a county-subsidized and private university hospital setting. Although condition on admission, use of resources, and outcome were unchanged in the private setting between 1980 and 1988, significant differences were noted among the largely uninsured patients at the county facility during this same time interval. There was a significant increase in the acuity of illness among patients undergoing cholecystectomy at the county hospital in 1988 as compared with 1980. These data suggest that alterations in reimbursement strategies and allocation of resources are significantly impacting on patient care, particularly in nonprivate health care facilities.

In this clinical study, four groups, each consisting of 12 patients are established to determine how gastric emptying is influenced in cholelithiasis with accompanied flatulent dyspepsia and the relationship of symptoms and gastric emptying after cholecystectomy. 1. group: healthy people, 2. group: patients with dyspeptic cholelithiasis, 3. group: patients who have no dyspepsia after cholecystectomy, 4. group: patients whose dyspepsia is continued after cholecystectomy. Groups are compared according to solid phase gastric emptying scintigraphies performed with Tc 99m sulfur colloid bound with scrambled eggs. Gastric emptying delayed in second (p < 0.001) and fourth (p < 0.005) groups postprandially and not differed in the third group (p > 0.005). These results demonstrate that dyspepsia, in cholelithiasis and persisting after cholecystectomy have a close relation with delay in gastric emptying.

As laparoscopic cholecystectomy has become more widely practiced, the full spectrum of complications associated with this technique is being realized. We have performed 283 consecutive laparoscopic cholecystectomies with no deaths and a morbidity rate of 5.3% (15 of 283 patients; six major complications, nine minor complications). Major complications included one bile duct injury requiring laparotomy and t-tube insertion and two patients with retained stones. Symptomatic bile leakage occurred in three patients (1%). Two of these bile leaks were from accessory ducts entering the gallbladder bed; the third leak was secondary to a cystic duct leak. Eight patients (2.8%) required conversion to open cholecystectomy. Minor complications included three patients with subumbilical wound infections, two patients with urinary tract infections, one patient with costochondritis after operation, and three patients with prolonged hospital stays (more than 48 hrs) caused by ileus or fever. Several patients with life-threatening complications, including two patients who ultimately died, were transferred to our care from other centers. These included two patients with common duct injuries combined with duodenal perforations (one of whom died), one patient with a complete common duct transection, one patient with major common hepatic duct injury, and two patients with further instances of bile leakage. Laparoscopic cholecystectomy can be performed safely, and it can be associated with life-threatening complications. Prevention of complications is dependent on proper patient selection, meticulous technique, and an accepting attitude toward conversion to "open" cholecystectomy.

Laparoscopic cholecystectomy (LC) is a minimally invasive method of removing the gallbladder that has become an accepted procedure all over the world. Authors performed 200 LC and compare the results of first 70 procedures with a matched group of patients who have undergone traditional cholecystectomy (TC) to evaluate its safety and efficacy. The average length of operation in the LC group was 64.5 +/- 26.3 min as compared to 68.5 +/- 22.5 min in the TC group. The difference between the incidence of postoperative complications in the 2 group was not statistically significant. The average length of stay in the LC group was 2.3 +/- 1.9 days versus 5.2 +/- 1.4 in the TC group. The difference is statistically significant. The comparison between the 2 methods shows less discomfort for LC patients during postoperative course. Pain was minimal, bowel evacuation was early and spontaneous, urinary retention only occurred in 2 patients versus 21 in TC group. The difference is statistically significant. Our results confirm laparoscopic cholecystectomy is a safe, effective and cost-efficient alternative to open cholecystectomy.

The article analyses surgical treatment of patients with cholelithiasis (231 persons) who were operated on with the use of a "pure" epidural block (59 patients), epidural block in combination with surface endotracheal nitrous oxide anaesthesia (100 patients), and general many--component anaesthesia (72 patients). The results show that epidural block is an effective method of neurovegetative protection of the organism from an operative trauma, provides rapid recovery of the organism for a state of operative stress, and is conducive to reduction of the number of postoperative complications. Administration of hydrocortisone and ephedrine is expedient for the prevention of arterial hypotension and its correction.

Duodenogastric reflux (DGR) has been suggested as an etiopathogenic factor in gastric disease in patients with gallstones. We evaluated the DGR levels in 15 patients before and after simple cholecystectomy for gallstones and compared the results with those of 15 healthy subjects. Gastric juice was obtained by continuous nasogastric suction for 24 hours. The bile acids (BA) present in the samples were quantified by thin-layer chromatography and in situ spectrofluorometry. The mean BA concentration for the control subjects was 2.25 mumol reflux/hour, whereas the mean value for the 15 patients with cholelithiasis was 8.86 mumol reflux/hour before cholecystectomy and 24.55 mumol reflux/hour after cholecystectomy. Five patients did not have detectable BA in the gastric juice in both analyses; the remaining 10 patients showed a significant increase in the BA after surgery. From these data, we conclude that gallstone disease is not always accompanied by an increased DGR. However, in patients in whom DGR is present, its level is higher than in control subjects and increases significantly after cholecystectomy. This is probably due to the greater amount of bile in the duodenum that may reflux through an incompetent pyloric channel.

We sought to determine the influence of operation on the pattern of human duodenal myoelectric activity and to assess whether electrical pacing might correct any postoperative disturbances. Three pairs of temporary bipolar serosal electrodes were placed on the duodenums of ten patients undergoing cholecystectomy. Electrical recordings were obtained daily until the patients' discharge, at 3 to 7 days, after operation. On each postoperative day, a regular rhythmic pattern of pacesetter potentials (PPs) was detected in all patients. The PP frequency (mean +/- SEM) was greater at the proximal electrode than at the distal electrode on the first postoperative day (12.3 +/- 0.1 cpm vs 11.9 +/- 0.1 cpm, p less than 0.01) and on the day of feeding (12.0 +/- 0.2 cpm vs 11.6 +/- 0.2, p less than 0.01). Spontaneous periods when spike potentials accompanied each PP (phase III of the migrating myoelectric complex), were found in only one patient on the day after operation, while they were recorded in five patients after 3 to 7 days, when postoperative ileus had resolved (p less than 0.05). Pacing with electric pulses (50 msec, 5 to 15 mA, 11 to 13 cpm) did not alter the pattern of duodenal PPs or entrain them in the duodenum of any patient at any time after operation. In conclusion, the pattern of duodenal pacesetter potentials changed little during the period of postoperative ileus, while the incidence of phase IIIs of the migrating myoelectric complex was greatly decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

In seven patients operated on with cholecystectomy for simple gallstones, sphincter of Oddi manometry was performed during surgery. The sphincter was localized as a zone with elevated base-line pressure and phasic contractile activity. Mean value of the amplitude was 90 mm Hg; wave duration, 4 sec; frequency, 5/min; and base-line pressure, 10 mm Hg. No activity was seen in the antrum or duodenum. The plotting of peak-to-peak intervals in a histogram showed that these were evenly distributed around 6 sec or at integrated multiples of this value. This indicates that the sphincter of Oddi is paced. The origin of the pacing is not yet established.

The functional activity of the sphincter of Oddi complex has been examined by ceruletide manometry in patients undergoing cholecystectomy with a normal peroperative cholangiogram. In Group I (n = 14), which included patients with previous acute cholecystitis/biliary colic, the sphincter activity appeared to be normal and responded to intravenous ceruletide by a marked relaxation with a significant fall in both the infusion and postinfusion pressures. In patients undergoing cholecystectomy for gallstone-associated pancreatitis (n = 8), the sphincter exhibited manometric features of hypotonia with low infusion and postinfusion pressures which were not significantly altered by intravenous ceruletide.

Intraluminal manometric and cine-cholangiomanometric studies were carried out on the movement of the sphincter of Oddi at the time of excretion of bile into the duodenum in 12 patients after cholecystectomy for gallstone. Two phases were observed in the sphincteric movement; the resting phase without any contraction and active phase with vigorous contraction. On stimulation with CCK-PZ 0.5 u/kg (bolus injection) in a active phase, a prompt transition from the active phase to the resting phase was observed in 4 to 8 minutes. On cine-cholangiomanometric study, the contrast medium injected into the common bile duct did not flow into the duodenum at the resting phase, but in the active phase. In the active phase, the excretion of the contrast medium was observed at the end of each contraction of the sphincter of Oddi. These observations have led a conclusion that bile excretion occurs in the active phase of the sphincter of Oddi in the cholecystectomized patients.

Previous studies using cholescintigraphy and measurement of bile salts in gastric juice have demonstrated that duodenogastric reflux is increased after cholecystectomy, a factor that may contribute to postoperative complaints in some patients. We studied 24-hour continuous gastric pH in healthy subjects, patients with cholelithiasis, and patients who had undergone cholecystectomy. Cholecystectomy decreased the percentage of time that gastric pH is below 2 and increased the time it is above 4 and 6. Furthermore, there was a greater increase in the more alkaline pH values in patients who were symptomatic than in those who were asymptomatic. The results demonstrated that cholecystectomy is associated with an alkaline shift in the 24-hour gastric pH profile that is most marked in symptomatic patients. This suggests that gastric alkaline episodes may be related to some postcholecystectomy symptoms.

The incidence of flatulent dyspepsia and its relationship to gallbladder function has been studied in 100 consecutive patients with gallstones undergoing cholecystectomy. Thirty-three per cent of patients suffered significant flatulent dyspepsia of whom 80 per cent were cured or improved by operation. In 15 patients gastric function was studied pre- and postoperatively and it was noted that there was no difference in gastric emptying times between patients with flatulent dyspepsia who were cured by operation and those who remained symptomatic. Bacteriological studies on gallbladder bile from 39 patients suggested that infection within the gallbladder may be a factor in the causation of flatulent dyspepsia.

In patients with sustained cholecystectomy the content of the basic bile components (cholesterol, cholic acid, total phosphorus) was measured. The cholate-cholesterol coefficient, enabling it to a certain degree to evaluate the lithogeneity of the bile, was calculated. The cholesterol concentration in the serum and bile was contrasted. A total of 104 patients were examined at different post-operative periodss and it was found that in 70 per cent of them the bile was not oversaturated with cholesterol. Two variants of the No. 5 diet were used--the sparing and fatty, differing in the amount of fat and carbohydrates. Under the effect of the No. 5 sparing diet a reduced serum cholesterol concentration was noted along with a noticeable rise of the cholic acid content in the bile with a not too brusque rise of the cholesterol level therein, which led to an increase of the cholate-cholesterol coefficient. Against the background of the treatment with a No. 5 fat diet in evidence was a diminution of the serum cholesterol content, a clearcut fall in the cholesteroland cholic acid concentration in the bile with a continuing fairly high cholate-chole sterol coefficient.

It has earlier been suggested that cholecystectomy, by eliminating the reservoir function of the gallbladder, will induce reflux of bile to the stomach. In the present study 23 patients were studied for duodenogastric reflux of bile acid before and 3 months after cholecystectomy. At the test the gastric contents were continuously aspirated via a nasogastric tube, collected at 15-min intervals for 2 h in the fasting patient, and analyzed for volume and bile acid concentration. The results were compared with those in 14 control subjects. Significant duodenogastric reflux of bile acid (greater than 100 mumol/h) was seen more frequently in gallstone patients than in controls. This is explained by a high prevalence of bile acid reflux in patients with a reduced or absent opacification of the gallbladder at cholecystography. Cholecystectomy increased the prevalence of bile acid reflux in the patients with well-opacified gallbladders at cholecystography. The duodenogastric reflux of bile acid in patients with a poor filling of the gallbladder at cholecystography was not further enhanced by cholecystectomy. It is concluded that gallstone patients have an increased tendency to duodenogastric reflux of bile acid. This tendency is further enhanced by removal of a functioning gallbladder. The findings may explain some of the symptoms in patients with gallstones. The reflux may also be responsible for symptoms in the so-called postcholecystectomy syndrome.

Mouth-to-cecum transit and serum bile acid profile after ingestion of a lactulose-labeled liquid meal (440 kcal) were measured in eight patients with gallstones and a radiologically functioning gallbladder before and three to five months after cholecystectomy and in 15 controls. In the patients mouth-to-cecum transit was longer after the operation, 87.5 +/- 18.5 (mean +/- SEM) min vs 57.5 +/- 9.7 min (P less than 0.05). Mouth-to-cecum transit times before and after the operation were not different from controls (58.0 +/- 6.7 min). Serum bile acid AUCs were similar (P = NS) in patients and controls, while total bile acid and cholylglycine fasting concentrations were higher after cholecystectomy (P less than 0.05 and P less than 0.01 respectively). Cholecystectomy prolongs mouth-to-cecum transit of a liquid meal.