TherapyTherapyТерапия2412-40362713-1823Bionika Media71760410.18565/therapy.2026.5.119-129REVIEWSОБЗОРЫReview ArticlePostcholecystectomy syndrome: Diagnosis and treatment problemsПостхолецистэктомический синдром: проблемы диагностики и леченияhttps://orcid.org/0000-0002-8488-92359455-3982OsadchukAlexey M.ОсадчукАлексей Михайлович
Russian Federation

MD, Dr. Sci. (Medicine), professor, professor of the Department of gastroenterology

д. м. н., профессор, профессор кафедры гастроэнтерологии

a.m.osadchuk2020@mail.ruhttps://orcid.org/0000-0002-3681-4132LoranskayaIrina D.ЛоранскаяИрина Дмитриевна
Russian Federation

MD, Dr. Sci. (Medicine), professor, head of the Department of gastroenterology

д. м. н., профессор, заведующий кафедрой гастроэнтерологии

gastromapo@yandex.ruhttps://orcid.org/0000-0002-0657-1280StepanovaElena V.СтепановаЕлена Владимировна
Russian Federation

MD, PhD (Medicine), associate professor of the Department of gastroenterology

к. м. н., доцент кафедры гастроэнтерологии

StepanovaEV@rmapo.ruRussian Medical Academy of Continuous Professional EducationФГАОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России290820261251191292908202629082026Copyright ©; 2026, “Bionika Media” LLCCopyright ©; 2026, ООО «Бионика Медиа»2026“Bionika Media” LLCООО «Бионика Медиа»https://journals.eco-vector.com/2412-4036/about/editorialPolicieshttps://journals.eco-vector.com/2412-4036/article/view/717604

The purpose of the current review is to present actual data on the definition, diagnosis, and treatment of conditions that arise after gallbladder removal. The authors analyzed scientific publications from 2010–2025 on the diagnosis and treatment of postcholecystectomy syndrome (PCS). Various organic and functional causes of pain after gallbladder removal are examined, and diagnostic issues and treatment approaches for various manifestations of PCS are discussed. Patient selection for cholecystectomy should be based on the risk of PCS developing. Integrated approach to diagnosing the causes of abdominal pain in PCS will allow timely initiation of treatment and minimize the risk of chronic health problems.

Цель настоящего обзора – представление актуальных данных о дефиниции, диагностике и лечении состояний, возникших после удаления желчного пузыря. Авторами проведен анализ научных публикаций за 2010–2025 гг., посвященных вопросам диагностики и лечения постхолецистэктомического синдрома (ПХЭС). Рассмотрены различные органические и функциональные причины болевого синдрома после удаления желчного пузыря, обсуждены вопросы диагностики, подходы к лечению при различных проявлениях ПХЭС. Отбор пациентов для холецистэктомии должен проводиться с учетом рисков развития ПХЭС. Интегрированный подход к диагностике причин абдоминальной боли при ПХЭС позволит своевременно начать терапию и минимизировать риск хронизации проблем здоровья.

postcholecystectomy syndromecholecystectomycholedocholithiasissphincter of Oddi dysfunctionпостхолецистэктомический синдромхолецистэктомияхоледохолитиаздисфункция сфинктера ОддиИвашкин В.Т., Охлобыстин А.В., Бордин Д.С., Селезнева Э.Я., Кучерявый Ю.А., Быстровская Е.В. с соавт. Резолюция Экспертного совета «Современный взгляд на проблему постхолецистэктомического синдрома». Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2017;27(6):96–108. [Ivashkin VT, Okhlobystin AV, Bordin DC, Selezneva EYa, Kucheryavy YuA, Bystrovskaya EV et al. Postcholecystectomy syndrome: The modern approach: Resolution of Advisory Council. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(6):96–108 (In Russ.)]. EDN: VXAVRZ.Jaunoo SS, Mohandas S, Almond LM. Postcholecystectomy syndrome (PCS). Int J Surg, 2010;8(1):15–17. PMID: 19857610. https://doi.org/10.1016/j.ijsu.2009.10.008Womack NA, Crider RL. The persistence of symptoms following cholecystectomy. Ann Surg. 1947;126(1):31–55. PMID: 17858976. PMCID: PMC1803303. https://doi.org/10.1097/00000658-194707000-00004Ильченко А.А. Почему холецистэктомия не всегда улучшает качество жизни? Фарматека. 2012;(17):23–29. [Ilchenko AA. Why does cholecystectomy not always improve quality of life? Farmateka. 2012;(17):23–29 (In Russ.)]. EDN: PJBMWF.Saleem S, Weissman S, Gonzalez H, Rojas PG, Inayat F, Alshati A. Post-cholecystectomy syndrome: A retrospective study analysing the associated demographics, aetiology, and healthcare utilize. Vinaya Gaduput Transl Gastroenterol Hepatol. 2021;6:58. PMID: 34805580. PMCID: PMC8573368. https://doi.org/10.21037/tgh.2019.11.08Kim YJ, Park YS, Shin CM, Han K, Park SH, Yoon H et al. Risk of heart disease after cholecystectomy: A nationwide population-based cohort study in South Korea. J Clin Med. 2021;10(15):3253. PMID 34362037. https://doi.org/10.3390/jcm10153253Tsai MC, Huang CC, Kao LT, Lin HC, Lee CZ. Increased risk of peptic ulcers following a cholecystectomy for gallstones. Sci Rep. 2016;6:30702. PMID: 27469240. PMCID: PMC4965818. https://doi.org/10.1038/srep30702Tyagi A, Tripathi A. Post cholecystectomy syndrome and its correlation with H. pylori infection along with endoscopic observations in a Tertiary Care Centre. Eur J Cardiovas Med. 2025;15(7):867–71. https://doi.org/10.61336/ejcm/25-07-147Mercan E, Duman U, Tihan D, Dilektasli E, Senol K. Cholecystectomy and duodenogastric reflux: interacting effects over the gastric mucosa. Springerplus. 2016;5(1):1970. PMID: 27917345. PMCID: PMC5108731. https://doi.org/10.1186/s40064-016-3641-zShabanzadeh DM. The symptomatic outcomes of cholecystectomy for gallstones. J Clin Med. 2023;12(5):1897. PMID: 36902684. PMCID: PMC10004100. https://doi.org/10.3390/jcm12051897Kim BT, Kim KM, Kim KN. The effect of ursodeoxycholic acid on small intestinal bacterial overgrowth in patients with functional dyspepsia: A pilot randomized controlled trial. Nutrients. 2020;12(5):1410. PMID: 32422942. PMCID: PMC7284594. https://doi.org/10.3390/nu12051410Huang Y, Cai Y, Chen Y, Zhu Q, Feng W, Jin L, Ma Y Cholelithiasis and cholecystectomy increase the risk of gastroesophageal reflux disease and Barrett’s esophagus. Front Med (Lausanne). 2024;11:1420462. PMID: 39091288. PMCID: PMC11292949. https://doi.org/10.3389/fmed.2024.1420462Li Z, Yang K. Bile reflux is associated with Barrett’s esophagus. Dig Liver Dis. 2024;56(6):1107–8. PMID: 38195347. https://doi.org/10.1016/j.dld.2023.12.016Ивашкин В.Т., Трухманов А.С., Маев И.В., Драпкина О.М., Ливзан М.А., Мартынов А.И. с соавт. Диагностика и лечение гастроэзофагеальной рефлюксной болезни (рекомендации Российской гастроэнтерологической ассоциации, Российского научного медицинского общества терапевтов, Российского общества профилактики неинфекционных заболеваний, Научного сообщества по изучению микробиома человека). Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2024;34(5):111–135. [Ivashkin VT, Trukhmanov AS, Maev IV, Drapkina OM, Livzan MA, Martynov AI et al. Diagnosis and treatment of gastroesophageal reflux disease (clinical guidelines of the Russian Gastroenterological Association, Russian Scientific Medical Society of Internal Medicine, Russian Society for the Prevention of Noncommunicable Diseases, Scientific Сommunity for Human Microbiome Research). Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2024;34(5):111–135 (In Russ.)]. EDN: BPZIFZ. https://doi.org/10.22416/1382-4376-2024-34-5-111-135Hines JH, Pillai S. Gallstone pancreatitis post laparoscopic cholecystectomy: A case report. Cureus. 2023;15(5):e39704. PMID: 3739878. PMCID: PMC10309077. https://doi.org/10.7759/cureus.39704Bistritz L, Bain VG. Sphincter of Oddi dysfunction: Managing the patient with chronic biliary pain. World J Gastroenterol. 2006;12(24):3793–802. PMID: 16804961. PMCID: PMC4087924. https://doi.org/10.3748/wjg.v12.i24.3793Халилова У.А., Скворцов В.В., Луньков М.В. Диагностика и лечение дисфункции сфинктера Одди. Экспериментальная и клиническая гастроэнтерология. 2018;(6):130–133. [Khalilova UA, Skvortsov VV, Lunkov MV. Diagnosis and treatment of Oddi ́s sphincter dysfunction. Eksperimental’naya i klinicheskaya gastroenterologiya = Experimental and Clinical Gastroenterology. 2018;(6):130–133 (In Russ.)]. EDN: UZUVRG.Kegnaes M, Novovic S, Shabanzadeh DM. Dysfunction of biliary sphincter of Oddi – clinical, diagnostic and treatment challenges. J Clin Med. 2023;12(14):4802. PMID: 37510917. PMCID: PMC10381482. https://doi.org/10.3390/jcm12144802Trinh A, Speer T, Liew D, Gibson R, Tjandra D, McKenzie D et al. Ursodeoxycholic acid treatment of LPAC presenting as post cholecystectomy pain: Rationale and design of a randomised trial. Transl Gastroenterol Hepatol. 2025;10:71. PMID: 41216274. PMCID: PMC12596452. https://doi.org/10.21037/tgh-24-127Xie ZQ, Li HX, Tan WL, Yang L, Ma XW, Li WX et al. Association of cholecystectomy with liver fibrosis and cirrhosis among adults in the USA: A population-based propensity score-matched study. Front Med (Lausanne). 2021;8:787777. PMID: 34917640. PMCID: PMC8669563. https://doi.org/10.3389/fmed.2021.787777Luo D, Chen XP, Dai Y, Kuang F, Kang MJ, Li B, Su S. Cholecystectomy and risk of liver disease: A systematic review and meta-analysis of 27 million individuals. Int J Surg. 2023;109(5):1420–29. PMID: 36999804. PMCID: PMC10389609. https://doi.org/10.1097/JS9.0000000000000332Wang Y, Xie LF, Lin J. Gallstones and cholecystectomy in relation to risk of liver cancer. Eur J Cancer Prev. 2019;28(2):61–67. PMID: 29738324. https://doi.org/10.1097/CEJ.0000000000000421Park S, Jeong S, Park SJ, Song J, Kim SM, Chang J et al. Associations of cholecystectomy with metabolic health changes and incident cardiovascular disease: A retrospective cohort study. Sci Rep. 2024;14(1):3195. PMID: 38326522. PMCID: PMC10850095. https://doi.org/10.1038/s41598-024-53161-6Драпкина О.М., Недогода С.В. Метаболически ассоциированная жировая болезнь печени при метаболическом синдроме. Российский кардиологический журнал. 2025;30(S1):91–98. [Drapkina OM, Nedogoda SV. Metabolic dysfunction-associated steatotic liver disease in metabolic syndrome. Rossijskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2025;30(S1):91–98 (In Russ.)]. EDN: QDDYDH. https://doi.org/10.15829/1560-4071-2025-6541Клинические рекомендации. Неалкогольная жировая болезнь печени. Российская ассоциация эндокринологов, Российская гастроэнтерологическая ассоциация, Общероссийская общественная организация «Российское научное медицинское общество терапевтов», Общероссийская общественная организация «Российская ассоциация геронтологов и гериатров», Российское общество по изучению печени, Российское общество профилактики неинфекционных заболеваний, Национальное общество профилактической кардиологии. Рубрикатор клинических рекомендаций Минздрава России. 2024. ID: 748_2. Доступ: https://cr.minzdrav.gov.ru/view-cr/748_2 (дата обращения – 25.03.2026). [Clinical guidelines. Non-alcoholic fatty liver disease. Russian Association of Endocrinologists, Russian Gastroenterological Association, Russian Scientific Medical Society of Internal Medicine, Russian Association of Gerontologists and Geriatricians, Russian Society for the Study of the Liver, Russian Society for the Prevention of Non-Communicable Diseases, National Society of Preventive Cardiology. Rubricator of clinical guidelines of the Ministry of Healthcare of Russia. 2024. ID: 748_2. URL: https://cr.minzdrav.gov.ru/view-cr/748_2 (date of access – 25.03.2026) (In Russ.)].Giakoustidis A, Papakonstantinou M, Gkoutzios C, Chatzikomnitsa P, Gkaitatzi AD, Myriskou A et al. Transient elevation of liver function tests and bilirubin levels after laparoscopic cholecystectomy. Medicina. 2024;60(11):1885. PMID: 39597070. PMCID: PMC11596356. https://doi.org/10.3390/medicina60111885Huang RL, Huang WK, Xiao XY, Ma LF, Gu HZ, Yang GP. Diagnosis and treatment of post-cholecystectomy diarrhoea. World J Gastrointest Surg. 2023;15(11):2398–405. PMID: 38111762. PMCID: PMC 10725554. https://doi.org/10.4240/wjgs.v15.i11.2398Ahmad DS, Faulx A. Management of postcholecystectomy biliary complications: A narrative review. Am J Gastroenterol. 2020;115(8):1191–98. PMID: 32483004. https://doi.org/10.14309/ajg.0000000000000704Печкуров Д.В., Тяжева А.А. Хологенная диарея: современное понимание механизмов, возможности диагностики и лечения. Практическая медицина. 2025;23(3):41–47. [Pechkurov DV, Tyazheva AA. Bile acid diarrhea: Modern understanding of the mechanisms, possibilities of diagnosis and treatment. Prakticheskaya medicina = Practical Medicine. 2025;23(3):41–47 (In Russ.)]. EDN: HTIPDT. https://doi.org/10.32000/2072-1757-2025-3-41-47Осадчук М.А., Осадчук А.М., Лоранская И.Д. Синдром раздраженного кишечника и СРК-подобные синдромы. Монография. М.: ГЭОТАР-Медиа. 2025; 176 с. [Irritable bowel syndrome and IBS-like syndrome. Monograph. Moscow: GEOTAR Media. 2025; 176 pp. (In Russ.)]. EDN: XUYKMU. ISBN: 978-5-9704-9265-9. https://doi.org/10.33029/9704-9265-9-IBS-2025-1-176Zhao J, Tian L, Xia B, Mi N, He Q, Yang M et al. Cholecystectomy is associated with a higher risk of irritable bowel syndrome in the UK Biobank: A prospective cohort study. Front Pharmacol. 2023;14:1244563. PMID: 38143491. PMCID: PMC10749201. https://doi.org/10.3389/fphar.2023.1244563Rana SV, Kar J, Gupta R, Gupta V, Sharma S, Malik A, Sinhaet SK. Effect of post-cholecystectomy on small intestinal bacterial overgrowth and orocecal transit time in gallstone patients. Int J Dig Dis. 2016;2:1. https://doi.org/10.4172/2472-1891.100023Тышевич Е.Н., Конорев М.Р., Иванова И.Н. Частота встречаемости синдрома избыточного бактериального роста в тонком кишечнике пациентов с желчекаменной болезнью (состояние после холецистэктомии) и лиц после эрадикации H. pylori. Лечебное дело. Научно-практический терапевтический журнал. 2017;(3):16–19. [Tyshevich EN, Konorev MR, Ivanova IN. The frequency of occurrence syndrome of bacterial overgrowth in small gut in patients with gallstone disease (a condition after cholecystectomy) and in persons after eradication of H. pylori. Lechebnoe delo. Nauchno-prakticheskiy terapevticheskiy zhurnal = Medical Practice. Scientific and Practical Therapeutic Journal. 2017;(3):16–19 (In Russ.)]. EDN: YTTEXF.Choi YJ, Jin EH, Lim JH, Shin CM, Kim N, Han K, Lee DH. Increased risk of cancer after cholecystectomy: A nationwide cohort study in Korea including 123,295 patients. Gut Liver. 2022;16(3):465–73. PMID: 35502586. PMCID: PMC9099388. https://doi.org/10.5009/gnl210009Huh JH, Lee KJ, Cho YK, Moon S, Kim YJ, Han KD et al. Cholecystectomy increases the risk of metabolic syndrome in the Korean population: A longitudinal cohort study. Hepatobiliary Surg Nutr. 2023;12(4):523–33. PMID: 37600984. PMCID: PMC10432299.34. https://doi.org/doi: 10.21037/hbsn-22-201Nam C, Lee JS, Kim JS, Lee TY, Yoon YC. Clinical perspectives on post-cholecystectomy syndrome: A narrative review. Ann Med. 2025;57(1):2496408. PMID: 40304725. PMCID: PMC12044903. https://doi.org/10.1080/07853890.2025.2496408Castillo J, Narayan S, Urreola G, Soufi K, Le M, Ortuno O. Risk factors associated with post-cholecystectomy syndrome and insights into post-surgical follow-up: Retrospective cohort study. J Surgery. 2024;4(2):1174.Bekkali NL, Oppong KW. How to manage postcholecystectomy abdominal pain. Frontline Gastroenterol. 2019;12(2):145–50. PMID: 33613947. PMCID: PMC7873542. https://doi.org/10.1136/flgastro-2019-101190Lee H, Kukreja Y, Niraj G. Interventional pathway in the management of refractory post cholecystectomy pain (PCP) syndrome: A 6-year prospective audit in 60 patients. Scand J Pain. 2023;23(4):712–19. PMID: 36779538. https://doi.org/10.1515/sjpain-2022-0090Ghamari MJ, Beyzaii H, Bahraminejad B, Mesbah N, Sobhani A, Mirsadeghi A. Intestinal ischemia: A rare and less common complication after laparoscopic cholecystectomy – a case report and literature review. Clin Case Rep. 2024;12(10):e9425. PMCID: PMC11442311. PMID: 39355769. https://doi.org/10.1002/ccr3.9425Kazi IA, Siddiqui MA, Thimmappa ND, Abdelaziz A, Gaballah AH, Davis R et al. Post-operative complications of cholecystectomy: What the radiologist needs to know. Abdom Radiol (NY). 2025;50(1):109–30. PMID: 38940909. PMCID: PMC11711778. https://doi.org/10.1007/s00261-024-04387-5Brimo Alsaman MZ, Mazketly M, Ziadeh M, Aleter O, Ghazal A. Cholecystocutaneous fistula incidence, etiology, clinical manifestations, diagnosis and treatment. A literature review. Ann Med Surg (Lond). 2020;59:180–85. PMID: 33082947. PMCID: PMC7554209. https://doi.org/10.1016/j.amsu.2020.09.035Sureka B, Mukund A. Review of imaging in post-laparoscopy cholecystectomy complications. Indian J Radiol Imaging.2017;27(4):470–81. PMID: 29379244 PMCID: PMC5761176. https://doi.org/10.4103/ijri.IJRI_489_16Bergeron E, Doyon T, Maniere T, Desilets E. Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event. Surg Endosc. 2023;37(12):9546–55. PMID: 37726412. PMCID: PMC10709473. https://doi.org/10.1007/s00464-023-10423-0Shrestha R, Chayaput P, Wongkongkam K, Chanruangvanich W. Prevalence and predictors of postcholecystectomy syndrome in Nepalese patients after 1 week of laparoscopic cholecystectomy: A cross-sectional study. Sci Rep. 2024;14(1):4903. PMID: 38418688. PMCID: PMC10902287. https://doi.org/10.1038/s41598-024-55625-1