Effect of cholecystectomy on bowel function: a prospective, controlled study.
Level 3 - non-randomized controlled study
Non-randomized prospective controlled cohort study
PubMed 10562588 · doi:10.1136/gut.45.6.889
What was done
A prospective controlled cohort study evaluated changes in bowel function following laparoscopic surgery. The study included 106 adults undergoing laparoscopic cholecystectomy (85 women, 21 men) and a control group of 37 women undergoing laparoscopic sterilisation. Before surgery and 2 to 6 months postoperatively, participants completed questionnaires regarding bowel frequency, bowel symptoms, diet, and medication use, and recorded stool form on a seven-point scale across five consecutive defecations.
What was found
In women undergoing cholecystectomy, self-reported bowel frequency on questionnaires increased by an average of 1 movement per week, with fewer patients perceiving constipation. However, prospective five-defecation records showed no consistent change in bowel frequency, stool form, or defecatory symptoms. Six women reported postoperative diarrhea, but it was new-onset in only 1 patient (in whom it was mild). Changes in dietary fiber intake were not associated with bowel changes, while stopping constipating drugs accounted for changes in a minority. No consistent bowel changes were observed in men undergoing cholecystectomy or in women undergoing sterilisation.
Why it matters
This study suggests that true clinical diarrhea after laparoscopic cholecystectomy is rare and mild, and that previously reported high rates likely reflect perceived changes, recall bias, or confounding factors such as medication adjustments.
Limits
The control group was non-randomized and comprised only women. The sample size for men was small (n = 21). Stool form was recorded for only five consecutive defecations, follow-up was limited to 2–6 months, and numerical statistical measures such as confidence intervals and p-values were not reported in the abstract.
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