Why does the pain still occur after gallbladder removal?

A cholecystectomy is a surgery to remove the gallbladder through a single large incision in the abdomen. It is also called an open cholecystectomy. Doctors perform this procedure to provide permanent help to patients and resolve the many issues related to gallbladder. Some patients who underwent endoscopic surgery involving the bile and pancreatic ducts reported significantly more persistent pain after gallbladder removal surgery than those treated with a placebo, according to a recent study.

Many patients undergo cholecystectomy every year, and at least 10% of them report persistent pain after surgery. Most of these patients have no obvious imaging or laboratory abnormalities, and the cause of their pain remains uncertain.

Many of these patients undergo a procedure called endoscopic retrograde cholangiopancreatography (ERCP), which involves using an endoscope to examine the pancreatic and common bile ducts in hopes of finding small stones or other pathology, or in an effort to address suspected sphincter of Oddi dysfunction. This dysfunction involves the muscles where the bile and pancreatic ducts connect to the small intestine that control the flow of digestive juices.

Of these patients, some undergo a biliopancreatic sphincterotomy (a surgical incision in the muscle that contracts to close the opening) or both. The value of this endoscopic intervention is unproven and the risks are significant. The incidence of pancreatitis associated with surgery is 10% to 15%, and perforation may occur. Many patients suffered long and costly hospital stays, and some even died, according to background information in the article.

"These findings do not support the use of ERCP and sphincterotomy in these patients," said study author Dr. Peter Bouton, professor of muscular gastroenterology and hepatology. "The finding that endoscopic papillary incision is not an effective treatment has major implications for clinical practice, as it applies to tens of thousands of patients."

Cotton and colleagues randomly assigned patients with postcholecystectomy pain to receive sphincterotomy or placebo after ERCP. When they re-looked at the patients' pain scores at predetermined intervals, the researchers noted that for a significant number of patients, pain scores had not improved and, in some cases, had increased.

Cholecystectomy is considered a safe procedure. Complications are rare. However, every surgical procedure carries some risks. Before surgery, your doctor will perform a complete physical examination and medical history to minimize these risks.