The effect of cholecystectomy on duodenojejunal motility in humans

We hypothesized that certain gastrointestinal symptoms following cholecystectomy could be explained by motor disturbances. To test this hypothesis, we compared pre- and post-operative motor patterns between symptomatic and asymptomatic patients after surgery to evaluate whether some motor changes could be induced by gallbladder removal and associated with symptoms. Twenty-three patients were prospectively evaluated before and 3 months after cholecystectomy. After surgery, 17 patients were asymptomatic and six were symptomatic. Duodenojejunal manometric recordings were performed for 3 h during fasting, then 3 h after a 750-kcal meal. Patient motor results were compared to those obtained in the duodenojejunum of 20 healthy controls. After surgery, only a few modifications in duodenojejunal motility were observed compared to the preoperative period. Motor changes related to cholecystectomy were increase in phase III amplitude and the absence of progressive decrease of the duodenojejunal motor response after the meal. After surgery, symptomatic patients had a lower postprandial duodenal motility index after the meal than asymptomatic patients (P < 0.03) and more frequent propagated clusters of contractions (PCCs) (P < 0.02). Preoperative motor patterns associated with postoperative symptoms were postprandial only and included a low duodenal motility index (P < 0.03), and a higher number of PCCs (P < 0.02). Removal of the gallbladder has a limited effect on duodenojejunal motility. Few motor differences existed between symptomatic and asymptomatic patients after surgery. However, a low duodenal motor response to a meal and PCCs were often associated with symptoms.