Patients who have previously undergone cholecystectomy may experience a collection of symptoms and clinical findings known as postcholecystectomy syndrome (PCS). It has been shown that this operation may have late sequelae, sometimes as a result of recurrent bile duct stones and the consequent constriction of those ducts.^1,2

Although it has been demonstrated that cholecystectomy is successful in relieving symptoms in 90% of cases, some patients continue to experience gastrointestinal symptoms despite surgical intervention. Furthermore, it has been noted that some patients developed symptoms that even began to resemble those that first appeared and motivated them to seek cholecystectomy.³

We find it to be very interesting to delve into the different symptoms that appear in PCS, and it is for this reason that we intend to reinforce the information in the article published in 2021 by Desai et al⁴ in the International Journal of Gastrointestinal Intervention, entitled "Foreign bodies in common bile duct in postcholecystectomy state—series of 8 cases: an experience of a single center in western India." That study presented several cases in which patients who underwent laparoscopic cholecystectomy presented with an obstruction in the secondary bile duct, stemming from foreign bodies.

Therefore, the clinical picture of common symptoms in PCS includes right hypochondriac pain, abdominal distension, and gastrointestinal issues, which may last more than 2 days following cholecystectomy.^3,4

For instance, Espinosa Brito et al⁵ and Schofer⁶ concur that postcholecystectomy complaints resemble the clinical symptoms of PCS, particularly dyspepsia and pain in the upper right quadrant of the abdomen, which were seen in 5% to 40% of all patients. While Shirah et al⁷ notes that these symptoms might develop slowly over months or years following cholecystectomy and are regarded as late symptoms, they can also develop almost immediately after surgery and are referred to as early symptoms.

However, Georgescu et al⁸ compared patients who had PCS with those who did not have PCS in 2022, and demonstrated changes in intestinal habits and microbiota in patients who had PCS. As a potential explanation for this, an imbalance between Firmicutes and Bacteroidetes was observed in PCS patients, but not in non-PCS patients. Thus, a post-interventional change in the organism's natural bacterial flora may cause the appearance of clinical symptoms.

It is crucial to understand how symptoms and dietary fat intake after cholecystectomy are related since, according to Yueh et al,⁹ eating a diet high in fats may be linked to the development of postcholecystectomy diarrhea induced by modifications in bile acid metabolism. However, the risk of PCS was not significantly correlated with fat intake in Shin’s study.¹⁰

Finally, considering the studies about the symptoms experienced by patients after cholecystectomy that we were able to review, it is critical to take these symptoms into consideration because, even though it may not seem like PCS occurs frequently, one needs to be familiar with its clinical picture.

The letter to the editor was self-funded.

No potential conflict of interest relevant to this article was reported.