Cholecystectomy and bowel function

Editor,—I read with great interest the article by Hearing et al (

) on the effect of cholecystectomy on bowel function. In this elegant publication, however, the authors mistakenly assume that published estimates of the prevalence of postcholecystectomy diarrhoea derive from retrospective or uncontrolled data only. In this context I would like to draw attention to earlier publications derived from the Rotterdam Gallstone Study.1 2

In the first paper the results are discussed of a prospective analysis of biliary and gastrointestinal symptoms (including diarrhoea) prior to and up to two years after gall stone therapy.1 Therapy consisted of either conventional cholecystectomy or extracorporeal shock wave lithotripsy (ESWL), allocated randomly. The second paper focused on surgery and reported on symptoms before and after conventional and laparoscopic cholecystectomy.2 This study was based on the same concept, and treatment depended on the availability of a laparoscopic set. Generally, we found that the reported incidence of diarrhoea before and after surgery did not change. In fact, there was no difference in the reported incidence of diarrhoea at any time between cholecystectomy and gall bladder preserving therapy (that is, ESWL). We also found that there were no differences in the reported incidence or severity of diarrhoea between laparoscopic and conventional cholecystectomy at any time.

Although the study design of our two studies differed largely from that of Hearing's, the results and conclusions are in agreement, in that clinical diarrhoea seldom develops after cholecystectomy. O'Donnell is correct that objective assessment rarely demonstrates new onset diarrhoea after cholecystectomy.3 I agree with Hearing et al that postcholecystectomy diarrhoea is in fact an unproved entity. Given our and Hearing's results, I doubt if more prospective studies are needed to solve this problem.